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Transplant Renal Artery Stenosis in Living Donor Kidney Transplant Recipients: A Single Center Experience from Nepal
(Institute of Medicine, 2022) Dhakal, Niraj; Sigdel, Mahesh R; Chalise, Pawan R; Bhurtyal, Nishan; Shah, Dibya S
ABSTRACT Introduction: Transplant renal artery stenosis (TRAS) is the most common preventable vascular complication in kidney transplantation with significant rates of graft loss and mortality. We aimed to study the demographics, prevalence, clinical presentation, and outcome of TRAS. Methods: We retrospectively reviewed medical records of all living donor kidney transplant recipients at Tribhuvan University Teaching Hospital from August 2008 to May 2021. Cases diagnosed with TRAS by ultrasound Doppler and/or renal CT angiogram were included. Data on demographics, clinical presentation, management, and outcomes were collected and analyzed. Among patients who underwent revascularization, pre and post-procedure creatinine, blood pressure (BP), and antihypertensive medicine burden were compared. Results: Among 620 living donor kidney transplantation, TRAS was present in 17 recipients (Male:Female = 16:1) (2.6%); mean age was 35.47±12.71 years. The median duration at diagnosis was one-month post-transplant (range: 5 days-9 months). The most common clinical features of TRAS were graft dysfunction and uncontrolled hypertension. Diagnosis of TRAS was confirmed with CT angiography in 13 patients. Ten patients underwent revascularization. Pre and post-revascularization mean serum creatinine was 356±210.49 μmol/L and 122.8±30.48 μmol/L (p=0.007) respectively, mean systolic BP was 200±12.47 mmHg and 133±13.38 mmHg (p=0.005) respectively and mean diastolic BP was 105±15.09 mmHg and 80±9.43 mmHg(p=0.005) respectively. Significant reduction in anti-hypertensive pill burden was achieved. Conclusion: Prevalence of TRAS was 2.6%. Most cases presented early with hypertension and graft dysfunction. Revascularization of significant stenosis had a favorable outcome in terms of BP control, antihypertensive pill burden, and preservation of renal function. Keywords: Renal allograft outcome, revascularization, TRAS
Tofacitinib as an Adjunct Immunomodulator for Treatment of a Patient with Severe COVID-19: A Case Report
(Nepal Medical Association, 2021) Shrestha, Gentle Sunder; Bista, Bidesh; Dhungana, Ashesh; Poudel, Nimesh; Bhattarai, Shraddha; Shrestha, Manjit; Bhandari, Sandip; Vaidya, Binit
Abstract: Severe coronavirus disease 2019 can be associated with progressive respiratory failure. In addition to respiratory support and other supportive care, use of corticosteroids has shown to improve outcome. Despite the use of steroids, a significant proportion of patients progressively worsen. Adjunct immunomodulators have been studied in addition to steroids in these patients. Here we present a successful use of tofacitinib, a Janus Kinase inhibitor, in conjunction with dexamethasone for a patient with rapid worsening of respiratory status and with high level of serum inflammatory biomarkers.
Pure Autonomic Failure: A Case Report of Recurrent Orthostatic Hypotension
(Nepal Medical Association, 2021) Khatri, Prabin; Panth, Himal; Khadka, Sabina; Thapa, Pramila; Regmi, Rajshree; Shah, Sunil; Gami, Sumit; Upadhyaya, Ashutosh; Alam, Mohammad Rizwan; Sharma, Srijana
Abstract: Pure autonomic failure is a neurodegenerative disorder affecting the autonomic nervous system which clinically presents with orthostatic hypotension. It is a diagnosis of exclusion after detailed clinical examinations and relevant investigations. Here, we discuss a case of 68 years old male who had complaints of multiple episodes of loss of consciousness on standing from a sitting position for the last 3 years. The diagnosis was considered by clinical examinations revealing autonomic dysfunctions with normal appropriate investigations. The patient was treated successfully with midodrine, fludrocortisone, and other non-pharmacological interventions. We focused on doing various autonomic dysfunction tests in the evaluation of a patient with recurrent orthostatic hypotension. We suspect that pure autonomic failure might not have been considered in the differential diagnosis of recurrent orthostatic hypotension and suggest that it is to be kept as a differential in such a scenario. Midodrine has an effective role in syncope due to sympathetic vasoconstrictor failure.
Suspicious Case of a Body packer “Mule” in a Low Resource Country: A Case Report
(Nepal Medical Association, 2021) Rajbhandari, Bibek; Shilpakar, Olita; Thapa, Subash; Singh, Sumi
Abstract: Body packing is the process of smuggling illicit drugs in the form of packages concealed within the gastrointestinal tract via ingestion or inserting into body orifices. These individuals are described as “body packers”, “stuffers”, “mules” or “swallowers” and resort to carrying drugs like heroin, cocaine and cannabis. They present to the hospital following the development of complications or brought dead due to the rupture of packets or directly from detention for further investigations. This case illustrates a suspected case detained from the airport who was found to be carrying 93 pellets of an illicit drug, heroin, weighing 900 grams, one of the highest quantity carried by any body packer in the country till date. This case further sheds light on the fact that a meticulous history, detailed clinical examination and radiographic investigations like abdominal radiograph and imaging are the keys to diagnose body packers in a resource limited setting.
Depression, Anxiety and Stress among Nepali Health Care Workers during the Coronavirus Disease 2019 Pandemic: A Cross-sectional Survey
(Nepal Medical Association, 2021) Sharma, Ishwor; Misra, Anurag; Shrestha, Bipin Kumar; Koirala, Arun Kumar; Banjade, Anita; Banjade, Prakash
Abstract: Introduction: Studies among health care workers from different part of world during the coronavirus disease 19 pandemic have reported substantial impact on their physical, mental and emotional well-being. This study measured the impact of coronavirus disease 2019 on the mental health of Nepali healthcare workers in different parts of the world during the pandemic. Methods: This cross-sectional survey was carried out from December 25, 2020 to Jan 25, 2021. Ethical approval was taken from the Institutional Review Committee (reference number: 372). Online questionnaire including demographic profiles and Depression, Anxiety, and Stress Scales-21 instrument were sent to Nepali healthcare workers around the world through social media apps using convenience sampling. Data were entered into Microsoft Excel for Mac version 16.49 and analysed. Results: Among 208 who participated in the study, 62 (30%) participants were positive for anxiety, 47 (22.5%) for depression and 25 (12%) for stress. Higher prevalence of depression 18 (30%) and stress 10 (17%) was found in nurses compared to paramedics, among whom depression was seen in 5 (20%) and stress in 4 (16%). Among doctors, depression was found in 24 (19%) and stress in 11 (9%). Conclusions: This study demonstrated that a high proportion of healthcare workers were suffering from depression, anxiety and stress. Our findings are similar to the data from other national and international studies.
Side Effects after Second Dose of Covishield Vaccine among Health Care Workers: A Descriptive Cross Sectional Study
(Nepal Medical Association, 2021) Pokharel, Khilasa; Dawadi, Bishwa Raj; Karki, Anup
Abstract: ABSTRACT Introduction: COVID 19 vaccination will protect us from getting COVID-19. Some side effects are common which are signs that our body is building protection. This side effects will go away in a few days. The aim of this study is to find out side effects seen among health care workers after second dose of covishield vaccination. Methods: This was a descriptive cross-sectional study conducted at Kathmandu medical college and Teaching Hospital from 22nd April 2021 till 30th April 2021. Ethical approval was revceived from Institutional Commitee of Institiute. Convienient sampling was done. The second dose of covishield vaccine was administered 12 weeks after its first dose. The vaccine was administered intramuscularly (IM) into deltoid muscle. Statistical Package for the Social Sciences were used for analysis. Results: Out of 220 cases taken, 135 were male and 85 were female. In our study 178 (80.90%) complaint of pain at injection site after second dose of covishield vaccine followed by 97 (44.09%) complaint of fatigue, 43 (19.54%) complaint of headache, 18 (8.18%) complaint of chills, 11 (5.00%)complaint of fever, 6 (2.72%) complaint of dizziness and 5 (2.27%) complaint of nausea. Conclusions: Pain at injection site, fatigue and headache were common side effects seen after second dose of Covishield vaccination.
Psychoactive Substance Use among Second-Year and Third-Year Medical Students of a Medical College: A Descriptive Cross-sectional Study Authors
(Nepal Medical Association, 2021) Sapkota, Alisha; Silvanus, Vinutha; Shah, Priyanka; Gautam, Sanjeev Chandra; Chhetri, Anjeel
Abstract: Introduction: Psychoactive substance use among medical students is common. This may not only pose a threat to their health and academic performance but may have medico-legal and ethical ramifications. The aim of this study was to find out the prevalence of six psychoactive substances (alcohol, tobacco, cannabis, cocaine, benzodiazepines, opioids) among second year and third year medical students. Methods: A descriptive cross-sectional study was done in a medical college. Whole sampling was done and ethical approval was taken from the Institutional Review Committee (Reference Number: 54-074/075). The study was conducted from May 2018 to June 2018. A semi-structured self-administered questionnaire modified and adapted from World Health Organization's guidelines for student substance use survey was used to collect data from second year and third year medical students. Statistical Package for Social Sciences version 16.0 was used for analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 226 total respondents, 95 (42.0%) (35.55- 48.45 at 95% Confidence Interval) reported current use of one or more psychoactive substances. Most frequently used substance was alcohol with current use prevalence of 87 (38.5%), followed by smoking 39 (17.3%) and cannabis 27 (11.9%). Cocaine, benzodiazepines and opioids were the least consumed substances with current use prevalence of 2 (0.9%) each. Conclusions: Almost half of the students were currently using one or more psychoactive substances which is concerning, and therefore strategies must be adopted to alleviate such use.
Psychiatric Disorders in Adolescents Attending Psychiatry Outpatient Department in a Tertiary Care Hospital: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2021) Joshi, Neelam; Shrestha, Asim; Karki, Deepika; Singh, Pradip Man
Abstract: Introduction: Adolescence is the time when most mental illness begins most of the time these problems are overlooked leading to increased morbidity and mortality. The study is undertaken to find out the prevalence of psychiatric disorders in adolescents attending psychiatry outpatient department in a tertiary hospital. Methods: A descriptive cross-sectional study was done from 1st December 2019 to 29th November 2020 at a tertiary care centre of Kathmandu. Ethical approval (Ref No.: 012-076/077) was taken from the Institution Review Committee. A semi-structured proforma was used for the socio-demographic profile of patients and International Classification of Diseases-10 was used to make the diagnosis. Data were analyzed using Statistical Package for the Social Sciences version 16. Results: A total of 174 adolescents were included in the study. Out of the total cases 141 (81.03%) (75.1-86.8 at 95% Confidence Interval) were diagnosed with psychiatric disorders, among them 73 (51.77%) were males and 68 (48.23%) were females. The common diagnoses were anxiety disorders 63 (36.20%), mood disorders 34 (19.54%), psychotic disorders 26 (14.94%), substance use disorders 8 (4.59%), non-organic sleep disorders 5 (2.87%), behavioral and emotional disorders 3 (1.72%) and mental retardation 2 (1.149%). Conclusions: Prevalence of psychiatric illnesses is high in the adolescent population compared to the similar studies.
Stress among Resident Doctors Working in Different Hospitals of Nepal in the Face of COVID-19 Pandemic: A Descriptive Cross-sectional Study Authors
(Nepal Medical Association, 2021) Adhikari, Gauri; Poudel, Leela; Pokhrel, Bidushi; Bhandari, Ganesh; Shrestha, Kshitij Kumar
Abstract: Introduction: The emergence and propagation of COVID-19 pandemic has subjected resident doctors to greater workload and consequent psychological implications. Many studies have illustrated various degrees of mental health issues among health care workers in general; however very limited ones have focused primarily on the resident doctors. Therefore, this study aimed to find out the prevalence of stress among the resident doctors of Nepal. Methods: A descriptive cross-sectional study was carried out in all the teaching hospitals of Nepal with ethical clearance from the Institutional Review Committee (Reference number-245). An online self-designed structured questionnaire developed using Google forms along with questions from stress subscale of Depression, Anxiety and Stress Scale - 21 was disseminated to the residents via social media platforms using Convenience sampling technique. Responses generated were analyzed with Statistical Package for the Social Sciences.Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: The prevalence of stress among resident doctors was found to be 16 (8.2%) (4.3-12.1 at 95% Confidence Interval). Greater prevalence of stress was seen among residents working outside Kathmandu valley, those in the frontline and those who were unmarried. Loss of collaborative study/ professional and academic growth experiences was responsible for causing extremely severe stress among 60 (30.9%) residents, followed by stress due to uncertainty regarding COVID-19 58 (29.9%) and unavailability/lack of quality control of personal protective equipment 58 (29.9%). Conclusions: This study has shed light upon the prevalence of stress and its precipitating factors in Nepalese resident doctors due to COVID-19 pandemic. Our findings could help address these issues for their mitigation promptly.
Hemodynamic Response to Laryngoscopy and Intubation Using McCoy Laryngoscope: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2021) Lakhe, Gajal; Pradhan, Suresh; Dhakal, Santosh
Abstract: Introduction: Laryngoscopy and intubation are stressful as they lead to a rise in heart rate and blood pressure. Though transient, it may be detrimental to the cardiac and neurosurgical patients. There is a need to explore the possibility of obtunding the pressor response to laryngoscopy and intubation with the use of McCoy blade laryngoscope. We aimed to find out the hemodynamic response to laryngoscopy and intubation using McCoy laryngoscope in adult patients undergoing general anesthesia. Methods: The descriptive cross-sectional study was conducted in 37 American Society of Anesthesiologists' Physical Status I/IIpatients, with normal airway from December 2019- May 2020 in a tertiary care hospital. Ethical approval was obtained from Institutional Research Committee (reference number.: MEMG/IRC/290/GA). Convenience sampling method was used. The mean systolic and diastolic blood pressures were measured at baseline, one, three and five minutes after laryngoscopy and intubation. Data were analyzed using the Statistical Package for the Social Sciences Version 21.0. Results: In the first minute after laryngoscopy and intubation, the rise in mean blood pressure was noted in 14 (37.83%) cases. The peak rise in mean blood pressure was 3%, note done minute after laryngoscopy and intubation. Conclusions: We noted better attenuation of pressor response to laryngoscopy and intubation using McCoy blade laryngoscope in adult patients undergoing general anesthesia.
Persistent Symptoms in Non-critical COVID-19 Patients at Two Months Follow-Up in a District Hospital: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2021) Tiwari, Bishal; Ghimire, Manoj; Bhatta, Gaurav; Banstola, Hemant; Tiwari, Bimala; Twayana, Anuradha; Shrestha, Karun
Abstract: Introduction: The corona virus disease 2019 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 belonging to corona viruses which are enveloped positive stranded RNA viruses. Non-critical coronavirus disease 2019 patients often lack follow up visits which has led to incomplete understanding of disease process. The aim of this study was to find out the prevalence of persistent symptoms in such patients during two months follow-up to a district hospital. Methods: This descriptive cross-sectional study was conducted in a district hospital from September 2020 to February 2021 among non-critical corona virus disease 2019 patients admitted to the isolation center of Nepal. Ethical approval was taken from the ethical review board of Nepal Health Research Council (reference number: 1707). Convenience sampling was done. Data was collected using a structured questionnaire. Data analysis was done using Statistical Package for the Social Sciences version 26. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 132 patients, 66 (50%) (41.5-58.5 at 95% Confidence Interval) patients had persistent symptoms at two-month follow-up. Forty-eight (36.4%) patients showed one symptom, 15 (11%) had two symptoms, and 3 (2%) had two or more symptoms. The most frequent symptom reported was fatigue in 17 (13%), cough in 15 (11%), myalgia in 9 (7%), and headache in 9 (7%). Conclusions: The prevalence of persistent symptoms at two months follow up in our study was lower than findings from other international studies.
Type A Cubital Venous Pattern among Students of a Dental College: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2021) Manandhar, Bipana; Shrestha, Ritee
Abstract: Introduction: Superficial veins in cubital fossa vary frequently in their anatomical pattern. The knowledge of variation of the cubital venous pattern is very essential for medical professionals for venous access during different medical procedures. This study aims to find the prevalence of Type A cubital venous pattern among students of a dental college. Methods: This descriptive cross-sectional study was conducted among 133 dental students of age 18 to 25 years in the department of anatomy of a dental college from November 2020 to February 2021. This study was conducted after obtaining ethical clearance from the Institutional Review Committee. Convenience sampling used and data was analyzed using Statistical Package for Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 133 dental students, Type A cubital venous pattern was found in 96 (72.18%) (64.56-79.79 at 95% Confidence Interval). Type A cubital venous pattern was seen in the left arm in 116 (43.61%) and in the right arm of 76 (28.57%) students. This pattern was noticed in 30 (22.55%) male and 103 (77.44%) female students respectively. Conclusions: This study showed higher Type A cubital venous pattern among dental students than other international studies.
Anxiety among Nursing Students towards Clinical Placement during COVID-19 in a Tertiary Hospital of Nepal: A Descriptive Cross-sectional Study Authors
(Nepal Medical Association, 2021) Banstola, Bidhya; Shakya, Nona; Sharma, Pushpa
Abstract: Introduction: The world is facing the pandemic of COVID-19 caused by the corona virus since December 2019 and has caused millions of death throughout the world. Exposure of nursing students in clinical placement during pandemic is fearful and stressful with high risk of infection which can cause anxiety and different levels of psychological crisis to individuals. The main objective of the study is to find out the prevalence of anxiety among nursing students during clinical placement in the pandemic of COVID-19. Methods: A descriptive cross-sectional study was conducted among 144 nursing students enrolled in different clinical placement of a tertiary hospital of Nepal from 20th January 2021 to 2nd February 2021. Ethical approval was received from the Institutional Review Committee. Demographic, COVID-19 related and Beck Anxiety Inventory questionnaires was used for assessing anxiety. Whole sampling was done. Descriptive statistics was conducted using Statistical Package for the Social Sciences 2016 version. Results: Out of 144 females enrolled in the study, all the nursing students 144 (100%) having clinical placement had anxiety. Among them, 117 (81%) had mild anxiety and 27 (19%) had moderate level of anxiety. All the students used coping strategies for the anxiety. The most commonly used strategy to cope with anxiety was religion (5.03±1.78). Conclusions: All the nursing students had anxiety during the clinical placement and all the students used the coping strategies for the anxiety. Majority of the nursing students had mild anxiety. Religion was most common method of strategy to cope with anxiety.
Self-medication in Primary Dysmenorrhea among Medical and Nursing Undergraduate Students of a Tertiary Care Hospital: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2021) Bharati, Jyoti Prabha; Ulak, Sanjay; Shrestha, Merina Vaidya; Dixit, Sanjay Mani; Acharya, Anna; Bhattarai, Ashish
Abstract: Introduction: Primary dysmenorrhea is one of the most common gynecological problems among adolescent females. It is defined as painful menses in women with normal pelvic anatomy, usually beginning during adolescence. This study aims to find out prevalence of self-medication practice in primary dysmenorrhea among medical and nursing undergraduate students. Methods: A descriptive cross-sectional study was conducted in a tertiary care hospital from November 2020 to March 2021 after taking ethical approval from the Institutional Review Committee. Convenient sampling technique was used. A total of 269 female medical and nursing students with complaints of dysmenorrhea were enrolled and the remedial methods used by them such as self-medication, medical advice and home remedies for dysmenorrhea were asked using an online questionnaire delivered to participants. Data analysis was done in the Statistical Package of Social Sciences. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Self-medication practice for dysmenorrhea was reported in 175 (65%) of students. The prevalence of mild or moderate pain was commonly present in age group 21-25 years. commonly used for self-medication was mefenamic acid 121 (48%), followed by ibuprofen 51 (20.3%) and paracetamol 41 (16.3%). Conclusions: Self- medication practice among medical and nursing undergraduate students is high despite awareness of adverse effects.
Study of Febrile Seizure among Hospitalized Children of a Tertiary Centre of Nepal: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2021) Pokhrel, Ram Prasad; Bhurtel, Radha; Malla, Kalpana Karmacharya; Shah, Love Kumar
Abstract: Introduction: Febrile seizure is the commonest cause of seizure in children and appears mostly between 6-60 months of life. The objective of this study is to find out the prevalence of febrile seizure among hospitalized children of a tertiary centre of Nepal. Methods: This is a descriptive cross-sectional study conducted in a teaching hospital of central Nepal, from 2014 January to 2019 December. After obtaining ethical clearance from Institutional Review Committee (Reference number: 2019-038), clinical and demographic data was retrieved from patient record retrospectively and reviewed for completeness and accuracy; those fulfilling the definition of febrile seizure were enrolled in the study. Convenience sampling technique was used. The data was analyzed using Statistical Packages for Social Sciences Version 25. Point estimate is done at 95% Confidence Interval and frequency and proportion was calculated. Results: Out of 4890 cases admitted during the study period, 214 (4.37%) (3.80%-4.94% at 95% Confidence Interval) children were diagnosed with febrile seizure. One hundred thirty one (62%) children had a simple febrile seizure. In majority of the cases, seizure lasted for less than 5 minutes; however, 10 (4.6%) of them presented with febrile status epilepticus, 111 (52%) children had generalised tonic seizure and upper respiratory tract infection was the commonest cause of fever. Conclusions: Prevalence of febrile seizure is significant among hospitalized children and simple febrile seizure is the commonest type. A substantial number of children present in febrile status epilepticus, even though the duration of febrile seizure is brief in most of the cases.
Study of Febrile Seizure among Hospitalized Children of a Tertiary Centre of Nepal: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2021) Pokhrel, Ram Prasad; Bhurtel, Radha; Malla, Kalpana Karmacharya; Shah, Love Kumar
Abstract: Introduction: Febrile seizure is the commonest cause of seizure in children and appears mostly between 6-60 months of life. The objective of this study is to find out the prevalence of febrile seizure among hospitalized children of a tertiary centre of Nepal. Methods: This is a descriptive cross-sectional study conducted in a teaching hospital of central Nepal, from 2014 January to 2019 December. After obtaining ethical clearance from Institutional Review Committee (Reference number: 2019-038), clinical and demographic data was retrieved from patient record retrospectively and reviewed for completeness and accuracy; those fulfilling the definition of febrile seizure were enrolled in the study. Convenience sampling technique was used. The data was analyzed using Statistical Packages for Social Sciences Version 25. Point estimate is done at 95% Confidence Interval and frequency and proportion was calculated. Results: Out of 4890 cases admitted during the study period, 214 (4.37%) (3.80%-4.94% at 95% Confidence Interval) children were diagnosed with febrile seizure. One hundred thirty one (62%) children had a simple febrile seizure. In majority of the cases, seizure lasted for less than 5 minutes; however, 10 (4.6%) of them presented with febrile status epilepticus, 111 (52%) children had generalised tonic seizure and upper respiratory tract infection was the commonest cause of fever. Conclusions: Prevalence of febrile seizure is significant among hospitalized children and simple febrile seizure is the commonest type. A substantial number of children present in febrile status epilepticus, even though the duration of febrile seizure is brief in most of the cases.
Experience of a Final Year Medical Student: Pre- and Post-COVID-19 Era
(Nepal Medical Association, 2021) Shrestha, Prinsa
Abstract: Medical education provides both knowledge and clinical skills to students. Clinical skills program including bedside teaching is considered an irreplaceable part of the undergraduate medical curriculum. COVID-19 pandemic has halted the delivery of effective clinical skills to medical students which has especially affected the final year students. So, we need to find an alternate approach to teach clinical skills to medical students in this era of COVID-19. This public health crisis has also demonstrated the significance of resilience and adaptability in the medical education system and the need to inculcate these values in our generation of medical students. This will help the students to complete their transition from a ‘student’ to a ‘doctor’. This article highlights the experience of a final year medical student in the pre- and post-COVID-19 period, problems faced by final year medical students during this crisis, and effective ways to cope up with them.
Anterior Cruciate Ligament Injury and its Rehabilitation in Nepal
(Nepal Medical Association, 2021) Bhusal, Suraj; Dotel, Ujjwal; Katila, Shamed Kumar; Shrestha, Saugat
Abstract: Anterior cruciate ligament is one of the most common ligaments to get injured especially in athletic population. It is a band of dense connective tissue which arises from the antero-medial aspect of the inter condylar area on the tibial plateau and passes upwards and backwards to attach to the posteromedial aspect of the lateral femoral condyle. There is increasing rate of its reported injuries among athletes in Nepal and surgeons report increased consultations among athletes regarding adequate intervention strategies. Factors like over use, inadequate recovery time, playing surface, fitness incompatibility are involved in the increase of anterior cruciate ligament injury among athletes in Nepal. Treatment approach for anterior cruciate ligament injury is ever evolving with regular studies and innovation, but constant guidance and rehabilitation in an institution-based setting have shown positive feedback in recovery and return to play.
Primary Immune Response Provides Protective Efficacy against SARS-CoV-2 Reinfection
(Nepal Medical Association, 2021) Shrestha, Rupendra; Shrestha, Reena; Khadka, Ram Bahadur; Gyawali, Rabin
Abstract: While there is absolutely no evidence to ensure recovered patients are either likely or unlikely to get reinfected. But studies in non-human primates indicate that reinfection of recovered patients is highly unlikely. It is also clear that primary immune responses or induced immunity to severe acute respiratory syndrome coronavirus 2 remain in circulation for several months and at least temporarily confer immunity to protect from reinfection. In addition, negative virus culture analysis of re-positive suggests that positive reverse transcriptase-polymerase chain reactions in recovered patients are more likely to be false-positive, or detection of genetic remnants of virus discharged from lesions of lungs or better sampling at the time of repeat analysis. However, emerging severe acute respiratory syndrome coronavirus 2 variants are likely to be causing the infections observed in some of the recovered patients.
Pituitary Apoplexy Complicated by Cerebral Infarction: A Case Report
(Nepal Medical Association, 2021) Pokhrel, Biraj; Khanal, Shambhu; Chapagain, Parikshit; Sedain, Gopal
Abstract: Cerebral infarction is a rare complication of pituitary apoplexy, which can result in significant morbidity if not treated on time. Pituitary apoplexy mostly occurs in pre-existing adenoma, which can remain undiagnosed until symptoms arise. Here, we present a case of a 26-year-old man with undiagnosed acromegaly who presented with left retro-orbital pain, diminished vision of the left eye, and right hemiparesis. Neuroimaging revealed large hemorrhagic sellar mass and ischemic infarction in the left middle cerebral artery territory. Emergency transcranial tumor excision was done, which resulted in significant neurological recovery.

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