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Relapsing Parvovirus B19 Infection after Intravenous Immunoglobulin in Renal Transplant Recipient: A Case Report
(Institute of Medicine, 2023) Nepali, Rabin; Chalise, Pawan R; Shah, Dibya Singh
ABSTRACT Parvovirus B19 has special affinity to erythroid progenitor cells leading to destruction and inhibition of erythropoiesis. One of its presentations is pure red cell aplasia in patients receiving immunosuppressive medications after organ transplantation. Intravenous immunoglobulin (IVIG) and reduction of immunosuppressive medication has been used for treatment but the effects of IVIG may be temporary. Here we present a case of Relapsing infection due to Parvovirus B19 after IVIG in a renal transplant recipient in Nepal. This case shows that in renal transplant patients presenting with anemia and low reticulocyte count, Parvovirus B19 infection should be suspected. Treatment with IVIG has good results but there may be relapse of infection. KeywordsParvovirus B19; intravenous immunoglobulin; renal transplant; relapse;
Association of Ovarian Reserves with Body Mass Index, Age and Vitamin D in Infertile Females
(Institute of Medicine, 2023) Rijal, Hima; Koirala, Poonam
ABSTRACT Introduction: Body mass index (BMI) may modulate ovarian reserve (OR) markers, and age-related fertility decline is well-established. Vitamin D has polygenetic effects on infertility, with its higher levels suggesting a positive correlation with OR markers. This study investigates the association of OR markers (AMH and FSH) with BMI, age and vitamin D in infertile females. Methods: An analytical study was conducted at Tribhuvan University Teaching Hospital, Nepal. The association of OR markers with BMI, age and Vitamin D level were analysed in infertile females over a year. Results: The study includes 186 infertile females, aged between 18 to 45 years. The study found no significant correlation between the OR marker (AMH) and body mass index (p = 0.92) or between OR (FSH) and BMI (p = 0.50). However, there was a significant negative correlation between age and BMI (p = 0.02). There was also a significant negative correlation between age and OR (AMH) (p = 0.04), but not between age and OR (FSH) (p = 0.09). And no significant correlation between vitamin D and OR (AMH/FSH) in infertile women, suggesting that vitamin D levels do not impact OR markers. Conclusion: The study found no significant association between OR markers, BMI, age and vitamin D in infertile women. Keywords: Anti-Müllerian hormone; body mass index; follicular stimulating hormone; infertility; ovarian reserve; vitamin D.
Buccal Mucosal Graft Urethroplasty for Complex Urethral Strictures: A Single Center Study
(Institute of Medicine, 2023) Chalise, Pawan R; Luitel, Bhojraj; Chapagain, Suman; Poudyal, Sujeet; Pradhan, Manish M; Parajuli, Purushottam; Sharma, Uttam K; Gyawali, Prem R
ABSTRACT Introduction: Urethral strictures have been a surgical challenge for the reconstruction urologists. Lichen sclerosus is the most common cause of urethral stricture in the developing world. There are different free graft tissues for urethroplasty but buccal mucosal graft (BMG) urethroplasty is an effective and versatile procedure for inflammatory and long segment urethral strictures. Methods: A total of 64 cases who had complex urethral strictures underwent dorsal onlay BMG urethroplasty. BMG was harvested from cheeks or sublingual mucosa depending upon the length of the stricture. The catheter was removed after 3 weeks and patients were evaluated with uroflowmetry. The surgery was considered successful if subjective and objective parameters were satisfactory. Results: Average length of the harvested graft was 14.5 cm (10-18 cm) in 42 panurethral, eight distal penile, four proximal penile and bulbar, and 10 bulbar urethral strictures. Postoperative period was uneventful except in four, of which two developed urethral fistulas and the other two developed periurethral abscess which resolved after treatment. After catheter removal, all voided with satisfaction. All patients, reassessed after mean period of 21 months, had satisfactory voiding. Two patients underwent visual internal urethrotomy for stricture at proximal site of BMG placement. There were no complications observed in the donor site with complete healing in all. Conclusion: Dorsal onlay BMG Urethroplasty is an effective and versatile procedure for anterior urethral strictures with excellent results and with minimal donor site morbidity. Keywords: Buccal mucosal graft; Lichen sclerosus; panurethral; urethroplasty
Arch Form and Mathematical Ratio in Orthodontics Patients: A Descriptive Cross-sectional Study
(Institute of Medicine, 2023) Maharjan, Surendra; Rajbhandari, Anjana; Pradhan, Resina; Bajracharya, Manju; Manandhar, Pushkar; Pant, Bashu D
ABSTRACT Introduction: Orthodontic treatment aims to achieve a pleasing and stable occlusion. To attain these, the patient's arch shape should be determined before treatment and maintained during treatment. Many attempts have been made to find out the original arch form, but those procedures have had some difficulties. The aim of this study was to determine the arch form using a comparatively simpler mathematical ratio. Methods: In this observational, descriptive cross-sectional study, 300 maxillary pretreatment casts from various malocclusion cases were collected. To determine the arch form, the mathematical ratio (CD/CW)/ (MD/MW) was used. Data were collected in Microsoft Excel and analyzed in IBM SPSS for descriptive statistics and one way ANOVA. Results: Among 300 individuals, 108 (36%) were males and 192 (64%) were females. In 29 (9.67%) males had square, 48 (16%) had oval, and 31 (10.33%) had tapered shaped arch forms, while 54 (18%) females had square, 77 (25.67%) had oval, and 61 (20.33%) had tapered shaped arch forms. The mean values of arch form were significant in both gender and age groups. Conclusion: The majority of participants had an oval arch form, followed by a tapered and square-shaped arch form. Keywords: Arch form; mathematical ratio; orthodontic treatment
Pediatric Intensive Care Unit in a Developing Nation: Exploring Acute Neurological Illnesses and Their Clinical Course
(Institute of Medicine, 2023) Khanal, Babita; Singh, Sandeep K; Mishra, Rajnish; Kafle, Prakash; Sharma, Mohan R
ABSTRACT Introduction: The burden of neurological illnesses is high in pediatric age group. Both primary neurological illnesses and neurological complication of systemic illness are commonly seen in pediatric intensive care unit (PICU). Neurological illness prolongs the length of PICU stay and also increases the mortality and morbidity.To assess the burden and describe the spectrum of acute neurological illness in a pediatric intensive care unit and analyze the early outcome. Methods: This was a prospective observational study conducted in Department of Pediatrics intensive care unit from January 2022 to December 2022. All children from 1 months to 16 years of age with neurological illness being admitted to PICU were included in the study. Basic demographic characters, diagnosis, treatment modalities and outcome were analyzed. Results: During study period, 237 (24.89%) were admitted to PICU with neurological illness. Mean age was 66 ± 42 months and 138 (58.22%) were male. Out of 237 children, 196 (82.70%) had primary neurological illness and 41 (17.30%) neurosurgical diagnosis. In primary neurological illness, 102 (52.10%) had primary CNS infection, followed by status epilepticus (21.52%), septic encephalopathy (11.70%), neuromuscular illness (8.16%), and metabolic encephalopathy (4.08%). In neurosurgical cases, 32 (78.04%) had Traumatic Brain Injury and 9 (22%) were shifted to PICU postoperatively. Mechanical ventilation was required in 156 (65.82%) and 88 (37.13%) required inotropic support. The mortality rate in neurological cases was 24 (10.12%) as compared to overall mortality rate of 6.8% in PICU. Conclusion: Neurological disorders are common in PICU and are associated with higher mortality rate. Primary central nervous system infection, severe traumatic brain injury and status epilepticus were common cause of PICU admission in our cohort. Keywords: Mortality; neurological illness; outcome; pediatric intensive care unit
Superficial Surgical Site Infection in Hand Surgery: A Cross-sectional Study in a Hand Surgery Unit
(Institute of Medicine, 2023) Bhandari, Prawesh S; Nakarmi, Kiran; Chaurasia, Lok R; Pudasini, Pushkar
ABSTRACT Introduction: Superficial surgical site infection (SSI) in hand surgery is generally considered to be less common. Infection of surgical site can lead to poor outcomes. Burden of surgical site infection in hand surgery has not been studied in our part of the world. We sought to determine the prevalence rate superficial surgical site infection in patients undergoing hand surgery. Methods: We used standard definition of CDC National Healthcare Surveillance Network (NHSN) criteria to evaluate 112 consecutive adults undergoing various hand surgery procedures outcome at the end of the second week for superficial SSI. The study was conducted over a period of six month (November 2022 to May 2023). Results: The prevalence of superficial surgical site infection was 6.25% . Among those affected 0.02% cases were diagnosed based on signs and symptoms criteria. In 0.03% patient the wound discharge yielded Staphylococcus aureus. The most common cause requiring hand surgery were workplace injuries, household injuries, and injuries due to road traffic accounting for 45.54%, 26.79%, and 18.75% , respectively. Crushing type of injury which was the most common of all mechanisms of injury. Conclusion: The prevalence rates of hand procedures are low but not negligible. This under-evaluated condition must be more extensively evaluated in a multicenter study involving larger population. Keywords: Hand surgery; surgical site infection
Prediction of Spontaneous Stone Expulsion by Serum C-Reactive Protein in Patients with Distal Ureteric Calculi
(Institute of Medicine, 2023) Raya, Akash; Rai, Binod K; Yadav, Aditya P; Shahi, Sanjiv K
ABSTRACT Introduction: Ureter obstruction caused by a ureteral stone triggers inflammatory change in the proximal submucosal layer and prevents passage of the stone which can increase C-reactive protein level. The present study was designed to see if CRP plays a role in predicting the expulsion of distal ureteric calculi of <10 mm in patients presenting to urology department. Methods: A cross-sectional study was done at National Medical College, Department of Surgery, Birgunj from January 2022 to June 2022. Total of 60 cases were included in the study who presented with distal ureteric calculi. Level of CRP was recorded and divided into <6 mg/dl and >6 mg/dl. Size of stone and rate of spontaneous expulsion was noted. Results: Among the 60 cases, 34 (56.7%) were males and 26 (43.3%) were females. Mean age of the study cases was 36.1±11.76 years and mean size of stone 6.72±1.54 mm. among the total cases 28 (47%) had CRP level <6mg/dl and 32 (53%) had CRP level >6mg/dl. Among the total cases 35 (58.3%) did not pass stone spontaneously and the size of stone was 6.9743±1.74598 mm. spontaneous passage of stone was not seen in 21 (60%) male and 14 (40%) female cases. Significant difference (p=<0.001) was seen between expulsion and non-expulsion of stone. Conclusion: Measurement of CRP at the time of presentation with distal ureteric calculi of small size can help the urologist to predict whether spontaneous expulsion is possible or not. Keywords: C-reactive protein; distal ureteric calculi; spontaneous expulsion of stone
Perioperative Outcomes following Surgery of Brain Tumors: Assessment and Analysis of Risk Factors
(Institute of Medicine, 2023) Kafle, Prakash; Rufus, Phelix; Paudyal, Nabin; Joshi, Narendra P; Khanal, Babita; Jonathan, Edmond; Bhandari, Binod R; Sharma, Mohan R
ABSTRACT Introduction: Cranial neurosurgery carries significant morbidity and mortality. Hence it is imperative to combine the latest available technological equipment with surgeon’s experience to prevent or reduce perioperative complications. It is also equally important to have a preoperative general assessment of the patient with functional status in particular to predict postoperative outcomes. Methods: This is a prospective study consisting of 122 patients selected over a period of 5 years (March 2017-March 2022). The patient database was retrieved from the medical record department, Nobel Institute of Neurosciences, Nobel Medical College Teaching Hospital, Biratnagar, Nepal and the approval of Institutional review committee was obtained. Age, gender, tumor related factors (site, extent and size), preoperative Glasgow Coma Scale (GCS) score, Karnofsky Performance Status (KPS) score and Modified Rankin scale (mRS) grade and their correlation with patient’s perioperative outcome were assessed. Results: Significant correlation was found between preoperative KPS score, mRS grade and patient’s perioperative outcome (low KPS score <70 and high mRS grade was associated with adverse outcomes). There was no positive correlation between age, gender and tumor related factors with outcomes. Conclusion: Low KPS score <70 and a high Modified Rankin scale score were associated with adverse perioperative outcomes in patient’s undergoing elective craniotomy for brain tumor surgery. Keywords: Brain tumor; preoperative KPS (Karnofsky performance status score); preoperative mRS (Modified Rankin scale score)
Caudal Dexmedetomidine versus Fentanyl with Bupivacaine in Decreasing Post-Operative Pain in Pediatric Inguinoscrotal Surgery : A Comparative Study
(Institute of Medicine, 2023) Gyawali, Nirman P; Shrestha, Reshma; Bhattarai, Krishna P; Malla, Sadikshya Shah
ABSTRACT Introduction: Despite various advancements in postoperative analgesia in children, about half of post-surgical children still experience pain. Opioids like fentanyl are used as an adjunct leading to a lower dose of caudal local anesthetics but have many side effects. Administration of caudal dexmedetomidine with local anesthetics was shown to prolong postoperative analgesia and sedation in children. This study was conducted to compare the effects of caudally administered fentanyl and dexmedetomidine in children undergoing inguinoscrotal surgery. Methods: This was a comparative clinical study in which 152 patients were included. Patients were divided into two groups to receive a caudal block, each having 76 cases. Group A and Group B received single-dose caudal analgesia using fentanyl (1mcg/kg) and dexmedetomidine (1mcg/kg) with 0.25% bupivacaine(0.75ml/kg), respectively. The analgesic effect of the caudal block was evaluated using the FLACC score and sedation using the RSS score. The statistical significance was evaluated using independent t test using confidence interval of 95% (p value<0.05). Results: The study showed no statistical significance in the demographic and operative variables between the two groups. The duration of analgesia (p value<0.001) and both the FLACC (p value=0.001) and RSS score (p value=0.004) only at 30 min postoperative values were statistically significant between the groups. The only side effect that showed statistical significance was vomiting (p value=0.03) seen in fentanyl group. Conclusion: Dexmedetomidine can thus be used safely in children along with bupivacaine in routine inguinoscrotal surgery with additional benefits of prolonged analgesia and decreased side effects. Keywords: Bupivacaine; fentanyl; dexmedetomidine; postoperative analgesia
Need of Specialized Courses in Advance Nursing Education in Nepal
(Institute of Medicine, 2023) Rai, Lalita; KC, Takma; Adhikari, Raj D; Acharya, Devaka; Sharma, Muna; Gautam, Roshani; KC, Tulaza; Das, Indra K; Shrestha, Shristy
ABSTRACT Introduction: Nursing specialization and certification of skill contribute nursing professionalism that improve nursing practice in an identified specific area within the entire field of professional nursing. Methods: A descriptive cross sectional survey was used for assessing the need of specialized courses in advanced nursing. Data was collected from January to March 2022 through an online survey among 354 nurses working in Nepal. Collected data was entered into SPSS version 16 and expressed by using descriptive statistics. Results: The findings showed that more than half (54.5%) of the participants were age group of 20-29, 99.4% were females, 50.3% had bachelor’s degree, 60.7% worked in government and 70.3% had working experience less than 10 years. Almost all (98.8%) felt importance of specialized courses in higher education and the needs of advanced courses (72.9%) and especially in critical care (53.1%) Almost all respondents (95.2 to 90.7%) perceived these courses increase self-esteem and morale, promote quality patient care, increase confidentiality and creditability, ensure competency, validate nurses’ knowledge and expertise, advancement of professional career ladder and clinical expert and increase professional accountability. Majority of them perceived (77.4%-57.6%) that specialty courses increase access to job-related power, obtain noticeable financial benefits and perform excellence services. Almost all (91.0%) of them perceived that it is beneficial to maintain professionalism. Conclusion: This study concluded that almost all graduate nurses felt specialty courses in masters degree for personal and professional development. Thus it is strongly recommended to initiate different specialized courses at the postgraduate level. Keywords: Advance nursing education; need; specialized courses
Temporal Trends, Socio-Economic Inequalities in Obesity and Responses by Federal Government, Nepal: A Systematic Review of Observational Studies, Policies, Strategies and Plans, 2005-2019
(Institute of Medicine, 2023) Bhurtyal, Ashok; Adhikari, Dushala
ABSTRACT Introduction: Obesity has risen to epidemic proportions in low-income countries like Nepal, where maternal and child under-nutrition has reduced steadily. However, synthesised evidence on transition to obesity remains unavailable. We assessed trends and disparities in obesity occurrence, and examined central government’s policies and programmes. Methods: We searched PubMed and Google Scholar for articles published between January 1, 2005 and April 10, 2019, and websites of Demographic and Health Survey, Non-Communicable Diseases Risk Factor Survey, and Micronutrient Status Survey. We synthesised obesity and overweight prevalence data from the selected studies, narratively; and disaggregated latest proportions from nation-wide surveys by gender, geographical location and household wealth quintile. We charted obesity related actions from policies, strategies and plans; obtained through the websites of health ministry and government’s planning commission. Results: Twenty studies with data from 79,082 men and women aged 15 years or more and 11,866 children under five years, were included. Obesity or overweight among men and women increased from 20.0% in 2004 to 36.1% in 2016. Obesity alone rose from 5.3% to 7.5%. National average prevalence of childhood obesity or overweight remained very low. Overweight and obesity were more common among women, inhabitants of urban areas and central provinces, and the affluent. Governmental policies, strategies and plans on nutrition were primarily designed to control under-nutrition, with implications for preventing obesity. Conclusion:Overweight and obesity increased substantially between 2005 and 2019, disproportionately affecting socio-economic and geographical groups. Governmental nutritional strategies should consider addressing obesogenic environments. Keywords: Malnutrition; nutrition transition; obesity; obesity prevention; overweight
Epidemiology and Demographic Profile of Inflammatory Bowel Disease in Nepal
(Institute of Medicine, 2023) Ranjan, Mukesh K; Pathak, Rahul
ABSTRACT Inflammatory bowel disease (IBD) is a chronic disease of the gastrointestinal tract. Once thought to be a disease of the developed nations, the burden of IBD has been rising in Asian countries. Inflammatory bowel disease leads to severe impairment in the quality of life of the patients. There have been numerous studies across the globe which have provided new insight into different aspects of this disease. Not only IBD is being diagnosed more but patients are also becoming more aware of this debilitating condition. It is encouraging to see a few studies from Nepal in the recent past. However, the epidemiological and demographic features of IBD remain largely unknown. Through this review, we aim to gain insight into the epidemiology and demographic features of patients with IBD in Nepal. Keywords: Crohn’s disease; epidemiology; inflammatory bowel disease; ulcerative colitis
Use of Screen Media And Mental Health: Effects On Adolescents And Pre-Adolescents Authors
(Nepal Medical Association, 2021) Adhikari, Bibek
Abstract: The children and adolescents of today’s generation are growing up in a media-saturated world. Digital media use has become the most common sedentary leisure time activity among children and adolescents. In the past decade, the development of mobile and digital technologies has taken place at such a rapid rate that researchers have had difficulties reporting evidence within limited timeframes. Growing evidence indicates that screen media usage by teenagers and pre-adolescents has deleterious ramifications on mental wellbeing. In addition to the benefits of screen media for exposure to a wide range of information and quick communication, the use of screen media has been correlated with adverse physical, psychological and social health consequences. This study focuses on the increasing use of screen media and their consequences on the various aspects of mental health of adolescents and preadolescents.
Mucormycosis: An unanticipated progeny of COVID-19
(Nepal Medical Association, 2021) Shrestha, Gentle Sunder; Bhandari, Sabin; Lamsal, Ritesh; Gurung, Urmila
Abstract: The rapid surge of COVID-19 cases in the second wave of the pandemic has crippled the healthcare delivery system in Nepal and neighboring countries. Unlike in the first wave of the pandemic, several cases of mucormycosis have been reported in patients with COVID-19 from Nepal and India. In this report, we briefly describe the clinical presentation, diagnosis, and risk factors for mucormycosis and explore why patients with COVID-19 are at an increased risk for developing the infection. As treatment of mucormycosis is challenging and consumes a lot of resources, prevention of mucormycosis is pivotal in low-income countries like Nepal. We also highlight some basic steps that are easy to perform and important to reduce the risk of infection.
Cannabis Use and Abuse in Nepal: A Review of Studies
(Nepal Medical Association, 2021) Shakya, Dhana Ratna; Upadhaya, Sandesh Raj; Thapa, Milan
Abstract: Nepal is a geographically, ecologically, bio-culturally and ethnically diverse country. Cannabis has been a flora, used in various forms and ways and its effect has been variably a matter of concern in Nepal. Perception to its use has also been changing with time with the dynamics of various factors and trends around and in the world. The views of its proponents at times appear with relatively more powerful influence among people though the views of the opponents seem less, and relatively less influential. Proponents advocate for its legalization with highlights of its different uses and benefits whereas opponents, mainly mental health professionals point out sporadically its adverse consequences, mainly in psychological health. The purpose of this review is to explore the existing literature regarding cannabis use and abuse in Nepal. Search for articles for this review was performed in PubMed, Google Scholar, and Nepal Journal Online. We summarize and discuss about cannabis in various aspects in the Nepalese context. The overarching objective is to reflect upon the ongoing debate regarding its harm and benefits, thereby upon the issue of its legalization in Nepal.
Hepatitis C Virus Infection in Pregnancy and Children: Its Implications and Treatment Considerations with Directly Acting Antivirals: A Review
(Nepal Medical Association, 2021) Rana, Ramesh; Dangal, Rajkumar; Singh, Yogendra; Gurung, Ram Bahadur; Rai, Bhim; Sharma, Amit Kumar
Abstract: Hepatitis C virus infection (HCV) is a global health problem affecting >71 million people worldwide with chronic hepatitis C, 40% reproductive age group, and 8% pregnant women. Intravenous drug abuse, multi-transfusions are major risk factors in adults, while vertical transmission in pediatric population. It commonly presents as a chronic liver disease, has higher risk of liver cirrhosis and even progression to hepatocellular carcinoma. Therefore, proper screening of high-risk populations including pregnancy is recommended. All diagnosed chronic hepatitis C cases should be treated with directly acting anti-virals (DAAs) including pre-conception which has a cure rate of >95%. This would reduce the disease burden, vertical transmission, and disability associated. However, no DAAs regimens recommendation till date due to lack of evidence on adverse fetal outcomes and are concerned about the pharmacokinetic effect regarding physiological changes during pregnancy. Therefore, in this review, we have tried to explore the possible use of DAAs regimens and their safety issues during pregnancy, and possible consideration of few pan-genotypic regimens in the late 2nd and early 3rd trimester. This would not only prevent vertical transmission and decrease disease burden but also help to meet the WHO 2030 target of HCV elimination as a major public health problem.
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, Swati
Abstract: 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.
Alopecia Universalis Associated with Hyperthyroidism Treated with Azathioprine and Hydroxychloroquine: A Case Report
(Nepal Medical Association, 2021) Paudel, Vikash; Chudal, Deepa; Pradhan, Manish Bhakta; Thakur, Rupa; Pandey, Buddhi Raj
Abstract: Alopecia universalis is an uncommon form of alopecia areata involving hair loss over the entire scalp and body. This condition is difficult to treat and sustain the growth of hair for longer duration. We report a case of alopecia universalis associated with severe hyperthyroidism. A lady in her fourth decade presented to us with gradual onset of alopecia universalis, who later found to have hyperthyroidism which was refractory to multiple treatment modalities. She was treated successfully with azathioprine and hydroxychloroquine. Alopecia universalis with less response to oral steroid therapy was successfully managed with azathioprine with hydroxychloroquine.
Interstitial Pregnancy Managed with Single-dose Systemic Methotrexate: A Case Report Authors
(Nepal Medical Association, 2021) Basnet, Tulasa; Yadav, Punita; Sah, Manoj Kumar; Yadav, Jyotsna
Abstract: Interstitial pregnancy is a rare type of ectopic pregnancy with a high risk of massive hemorrhage on rupture as compared to ectopic on other sites. The mortality rate for the ruptured interstitial pregnancy is high. Therefore, early diagnosis of such pregnancy before the rupture occurs facilitates appropriate management and avoids life-threatening complications. With the advancement in diagnostic imaging modalities, early diagnosis and more conservative management for interstitial pregnancy have become possible. Here, we report a case of primigravida diagnosed with interstitial pregnancy with ultrasonography and successfully managed with a single dose of methotrexate.
Stuttering after Intravenous Anesthesia: A Case Report
(Nepal Medical Association, 2021) Lamichhane, Suraj; Upreti, Murari Raj; Dhakal, Yogesh
Abstract: Stuttering is a form of speech disorder characterized by involuntary prolongation and repetition of sound, words, syllables or phrases as well as involuntary silent pauses or blocks. We report a case of a healthy twenty-six-year-old male patient without significant past history, who underwent short intravenous anesthesia for incision and drainage for perianal abscess. Postoperatively, the patient presented with prominent stuttering after six hours of surgery. To our knowledge, this is the first reported case of stuttering following short intravenous anesthesia without any airway manipulation. He was diagnosed with a functional speech disorder after excluding organic causes. His speech eventually normalized with six weeks of intensive speech therapy. This event posed a significant challenge for the surgical and anesthesia team to find the potential cause, to plan further management, and lead to two days prolongation of hospital stay.

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