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Lamichhane B, Lamichhane S, Paudel K, Pokhrel NB, Dhital S, Acharya SK. Culture-negative endocarditis with multifocal spread and flail mitral valve leaflet: a case report. Ann Med Surg (Lond) 2024; 86:1161-1165. [PMID: 38333264 PMCID: PMC10849347 DOI: 10.1097/ms9.0000000000001638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/11/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction Blood culture-negative infective endocarditis is the condition in which a causative organism cannot be identified after inoculation of at least three samples using standard blood-culture systems for 7 days. It has a low reported incidence of about 2.5-31%. Causes may be infectious or non-infectious; use of prior antibiotic therapy is usually the leading factor. Case presentation The authors present a case of true culture-negative endocarditis involving the mitral valve, with multiple foci of spread including brain, spleen, liver, and Intervertebral disc, which remained persistent despite treatment with intravenous broad-spectrum antibiotics on an inpatient and outpatient basis but eventually improved after upgrading alternative broad-spectrum antibiotic for an extended duration. The patient had complications in the form of a flail mitral valve with persistent mitral regurgitation, requiring mitra-clip placement. Discussion Positive blood culture is one of the major diagnostic criteria to establish infective endocarditis. Patients may have persistent negative cultures due to previous antibiotic use, the presence of fastidious organisms, or the use of inappropriate techniques or media. Involvement of a multidisciplinary team, use of multimodal investigations, and appropriate antibiotic stewardship are crucial. Extended duration of treatment and upgrading antibiotics can be helpful next steps in highly suspicious cases. With multifocal spread as in our case, it further becomes challenging to control and treat the infection as it is frequently connected with higher morbidity and mortality. Conclusion Blood culture-negative endocarditis is an entity that can present with early complications. It is diagnostically and therapeutically challenging to treat such patients. Multimodal approaches for early diagnosis and appropriate treatment are crucial owing to its high morbidity and mortality.
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Affiliation(s)
| | | | | | - Nishan B. Pokhrel
- Internal Medicine, Tribhuvan University, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Sandhya Dhital
- Internal Medicine, Kern Medical Center/Ross University School of Medicine, Castro Valley, FL
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2
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Ghimire Padhya I, Lamichhane S, Devkota P, Gurung P, Aryal P. Atraumatic Bilateral Patella Fracture in Middle-Aged Female: A Rare Case Report. Case Rep Orthop 2024; 2024:6661957. [PMID: 38298465 PMCID: PMC10827372 DOI: 10.1155/2024/6661957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/21/2023] [Accepted: 01/13/2024] [Indexed: 02/02/2024] Open
Abstract
The patella is the largest sesamoid bone in the body and an important structure of the extensor apparatus which is under undue stress during flexion and extension of the knee. Bilateral fracture of the patella without trauma is a very rare event and may be multifactorial without a single cause. A repetitive stress reaction in a previously predisposed bone can be an important cause. We report a case of a 45-year-old female with a nontraumatic bilateral transverse patella fracture with loss of extensor mechanism. A stable surgical fixation for such a displaced fracture with a good rehabilitation program can lead to a good functional outcome.
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3
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Basnet A, Kansakar S, Sharma NR, Gautam S, Lamichhane S, Tiwari K, Pokhrel M, Singh S. Granulomatosis with polyangiitis mimicking COVID-19 pneumonia: A case report. Clin Case Rep 2023; 11:e8007. [PMID: 37808571 PMCID: PMC10558652 DOI: 10.1002/ccr3.8007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/27/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023] Open
Abstract
Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is a necrotizing vasculitis characterized by small-to-medium-sized vessel involvement and the presence of antineutrophil cytoplasmic antibodies (ANCA). We present a case of a 26-year-old Asian woman who was transferred to our center from a nearby hospital, where she presented with shortness of breath, tested positive for COVID-19, and was being managed for COVID-19 pneumonia. She also had hemoptysis, skin lesions, and left foot numbness. Serological markers and VATS-guided lung biopsy confirmed the diagnosis. Treatment with methylprednisolone and rituximab led to stabilization, despite complications of subcutaneous emphysema and lower extremity neuropathic symptoms. Early recognition and appropriate management of GPA are crucial for optimal outcomes.
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Affiliation(s)
- Arjun Basnet
- Maimonides Medical Center Brooklyn New York United States
| | - Sajog Kansakar
- Maimonides Medical Center Brooklyn New York United States
| | | | | | | | - Kripa Tiwari
- Maimonides Medical Center Brooklyn New York United States
| | - Madalasa Pokhrel
- Montefiore New Rochelle Hospital New Rochelle New York United States
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4
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Basnet A, Naeem A, Sharma NR, Lamichhane S, Kansakar S, Gautam S, Tiwari K, Seitillari A, Thomas R, Janga K. Atrial Fibrillation Ablation in Patients With Chronic Kidney Disease: A Review of Literature. Cureus 2023; 15:e46545. [PMID: 37927624 PMCID: PMC10625454 DOI: 10.7759/cureus.46545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Atrial fibrillation (AF) is a common arrhythmia among patients with chronic kidney disease (CKD), which leads to increased cardiovascular complications. Catheter ablation (CA) has emerged as an effective and safe treatment for AF in CKD patients. CA offers tailored treatment strategies and presents a safer alternative with fewer adverse outcomes than anti-arrhythmic agents. Although CKD patients undergoing ablation have similar complication rates to non-CKD patients, they face a higher risk of hospitalization due to heart failure. Furthermore, CA shows promise in improving kidney function, particularly in individuals who maintain sinus rhythm. Future research should address limitations by including advanced CKD patients, conducting longer-term follow-ups, and developing individualized treatment approaches.
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Affiliation(s)
- Arjun Basnet
- Internal Medicine, Maimonides Medical Center, Brooklyn, USA
| | - Azka Naeem
- Internal Medicine, Maimonides Medical Center, Brooklyn, USA
| | - Nava R Sharma
- Medicine, Manipal College of Medical Sciences, Pokhara, NPL
| | | | - Sajog Kansakar
- Internal Medicine, Manipal College of Medical Sciences, Pokhara, NPL
| | | | - Kripa Tiwari
- Internal Medicine, Maimonides Medical Center, Brooklyn, USA
| | | | - Remil Thomas
- Internal Medicine, Nuvance Health Vassar Brothers Medical Center, New York, USA
| | - Kalyana Janga
- Nephrology, Maimonides Medical Center, Brooklyn, USA
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5
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Sharma NR, Basnet A, Lamichhane S, Kansakar S, Seitillari A, Rivera Boadla ME, Gautam S, Kc P, Tiwari K, Singh A, Basnet S, Lamichhane B, Pokhrel M. Outcome of Atrial Fibrillation Ablation in Cancer Patients: A Review. Cureus 2023; 15:e47818. [PMID: 38022229 PMCID: PMC10676746 DOI: 10.7759/cureus.47818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Atrial fibrillation (AF), a cardiac arrhythmia, exhibits a heightened prevalence among individuals diagnosed with cancer, notably prominent in cases of lung and gastrointestinal malignancies. Robust evidence from extensive studies underscores this association, emphasizing its clinical significance. However, the precise mechanistic underpinnings and specific risk factors linking cancer and AF remain a subject of incomplete understanding. Notably, the prevalence of AF in cancer patients substantially exceeds that in non-cancer counterparts, prompting further exploration of the underlying pathophysiological processes. This review aims to address the existing knowledge void regarding AF management in cancer patients, with a specific focus on the potential role of ablation procedures. While catheter and surgical ablation techniques have been thoroughly investigated and validated as effective treatments within non-cancer populations, their applicability and outcomes in cancer patients have remained inadequately explored. The principal objective of this exhaustive review is to bridge this research gap by conducting a meticulous examination of the feasibility, safety, and effectiveness of ablation interventions for AF in the context of cancer patients. By amalgamating existing evidence and pinpointing critical areas necessitating additional investigation, this review endeavors to provide invaluable insights into AF management in cancer patients, with the ultimate goal of enhancing their clinical care and optimizing outcomes.
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Affiliation(s)
- Nava R Sharma
- Medicine, Manipal College of Medical Sciences, Pokhara, NPL
| | - Arjun Basnet
- Cardiology, Tower Health Medical Group, West Reading, USA
| | | | - Sajog Kansakar
- Internal Medicine, Manipal College of Medical Sciences, Pokhara, NPL
| | | | | | | | - Prabal Kc
- Internal Medicine, Rasuwa District Hospital, Kathmandu, NPL
| | - Kripa Tiwari
- Internal Medicine, Maimonides Medical Center, Brooklyn, USA
| | | | - Sijan Basnet
- Internal Medicine, The Reading Hospital and Medical Center, Wyomissing, USA
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6
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Bhattarai HB, Basnet B, Bhattarai M, Shrestha A, Gautam S, Lamichhane S, Uprety M, Pokhrel B, Sah SK, Yadav J. Diagnostic pitfalls in young onset parkinsonism and its unique challenges: A case report from rural Nepal. SAGE Open Med Case Rep 2023; 11:2050313X231197062. [PMID: 37663151 PMCID: PMC10474787 DOI: 10.1177/2050313x231197062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023] Open
Abstract
Parkinson's disease is a neurodegenerative disease resulting from the loss of dopamine-secreting neurons present in the substantia nigra of the brain. Parkinson's disease is classified as early-onset and late-onset disease based on the time of its presentation. Since young patients with Parkinson's disease have an atypical clinical presentation and have to deal with their careers, raising families, or both at the time of diagnosis and also have a higher risk of drug-related side effects, it poses unique challenges for the patient, clinical team, and community. We present the case of a 40-year-old female with young onset Parkinson's disease from rural Nepal and the challenges faced during and after the disease in a resource-limited setting.
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Affiliation(s)
| | | | | | - Ayush Shrestha
- Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | | | - Saral Lamichhane
- Gandaki Medical College Teaching Hospital and Research Center Pvt Ltd, Pokhara, Nepal
| | - Manish Uprety
- Kathmandu University School of Medical Sciences, Kathmandu, Nepal
| | - Bidushi Pokhrel
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | | | - Jayant Yadav
- Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
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7
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Bhattarai HB, Thapaliya I, Dhungana S, Singh PB, Bhattarai M, Pokhrel B, Khanal S, Lamichhane S, Gautam S, Basnet B. Unilateral proptosis in a patient with thyroid eye disease: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231190669. [PMID: 37533488 PMCID: PMC10392154 DOI: 10.1177/2050313x231190669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023] Open
Abstract
Unilateral proptosis is an abnormality in which one eye sticks out forward more than the other. Bulging of the eye is commonly seen in Graves' ophthalmopathy, but it's mostly bilateral. Thyroid eye disease presents as the most common extrathyroidal manifestation of Graves' disease, and rarely leads to unilateral proptosis. A 25-year-old female with a history of weight loss, menstrual irregularities, and palpitations presented with progressive right eye bulging, which was further confirmed by magnetic resonance imaging and biochemical investigations. Magnetic resonance imaging of the orbit revealed unilateral extraocular muscle enlargement and enhancement with sparing of the tendons. Timely therapy is crucial for reversing the ocular manifestations of thyroid eye disease.
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Affiliation(s)
| | | | | | | | | | - Bidushi Pokhrel
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Santosh Khanal
- Tribhuvan University, Institute of Medicine, Maharajgunj, Nepal
| | - Saral Lamichhane
- Gandaki Medical College, Teaching Hospital and Research Center, Pokhara, Nepal
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8
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Gautam S, Sharma NR, Kansakar S, Lamichhane S, Pokhrel M, Basnet A. Infective endocarditis presenting as meningitis: a case report. Ann Med Surg (Lond) 2023; 85:3638-3641. [PMID: 37427202 PMCID: PMC10328663 DOI: 10.1097/ms9.0000000000000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/14/2023] [Indexed: 07/11/2023] Open
Abstract
Infective endocarditis (IE) primarily affects the endocardium of heart valves. Neurologic manifestations include strokes, intracerebral hemorrhages, meningitis, cerebral and spinal abscess, and mycotic aneurysms. Although rare, meningitis is a potentially life-threatening complication of IE, so physicians should be aware of this rare and fatal complication of IE. Case presentation Here, the authors present a case of a 53-year-old male who presented with bacterial meningitis secondary to IE. His blood culture was positive for methicillin-sensitive staphylococcal aureus. Echocardiography findings were suggestive of endocarditis. Despite aggressive intensive care management, our patient did not survive. Clinical discussion The isolation of Staphylococcus aureus in culture should raise a suspicion of foci being elsewhere outside the central nervous system. Treatment of complications like meningitis may require intrathecal antibiotics. The vegetation and neurological complications are often difficult to treat and require the participation of a multidisciplinary team. Conclusions The diagnosis of IE in patients presenting with neurologic deficits and fever should be considered. A physician should raise a suspicion of infective foci being elsewhere outside the central nervous system if the organism isolated in culture is Staphylococcus aureus.
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9
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Bhattarai HB, Lamichhane S, Bhattarai M, Subedi P, Acharya S, Singh PB, Pandit R, Joshi S, Subedi A, KC M. A case report on agenesis of dorsal pancreas with insulin-dependent diabetes mellitus: a rare entity. Ann Med Surg (Lond) 2023; 85:3626-3629. [PMID: 37427208 PMCID: PMC10328632 DOI: 10.1097/ms9.0000000000000890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/14/2023] [Indexed: 07/11/2023] Open
Abstract
Agenesis of the dorsal pancreas (ADP) is a clinically rare entity that occasionally presents with abdominal pain. It is also association with various disorders of glucose metabolism. Case presentation A 23-year-old male presented with continuous epigastric pain for 4 h and intermittent vomiting. He has a history of experiencing recurrent abdominal pain and diarrhoea for the past 5 years. Additionally, he has been diagnosed with type 1 diabetes mellitus for 15 years. Contrast-enhanced computed tomography of the abdomen showed the absence of body and tail of the pancreas. Discussion ADP is caused by unknown factors, but may be linked to genetic mutations or changes in signalling pathways related to retinoic acid and hedgehog. Symptoms can be absent, but may include abdominal pain, pancreatitis, and hyperglycaemia due to beta-cell dysfunction and insulin deficiency. Imaging modalities, such as contrast tomography or magnetic resonance cholangiopancreatography, or endoscopic retrograde cholangiopancreatography, are crucial in the diagnosis of ADP. Conclusion It is important to consider ADP as a differential diagnosis in patients with glucose metabolism disorders and associated symptoms such as abdominal pain, pancreatitis, or steatorrhea. It requires the combined use of imaging modalities such as ultrasound, contrast tomography, magnetic resonance cholangiopancreatography, or endoscopic retrograde cholangiopancreatography, as ultrasound alone may not provide a complete diagnosis.
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Affiliation(s)
| | - Saral Lamichhane
- Gandaki Medical College, Teaching Hospital and Research Center, Pokhara
| | | | | | | | | | | | | | | | - Manish KC
- Kist Medical College and Teaching Hospital, Lalitpur
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10
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Basnet A, Sharma NR, Lamichhane S, Tiwari K, Varghese J, Kansakar S, Gautam S. Reverse takotsubo syndrome heralding as ventricular fibrillation: a case report. Ann Med Surg (Lond) 2023; 85:3744-3747. [PMID: 37427166 PMCID: PMC10328657 DOI: 10.1097/ms9.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023] Open
Abstract
Reverse takotsubo syndrome, a variant of takotsubo cardiomyopathy, is an acute left ventricular failure characterized by the basal akinesis/hypokinesis associated with apical hyperkinesis. Its presentation is similar to that of the acute coronary syndrome. Case presentation The authors present a case of a 49-year-old woman, a vice principal at a local school with a history of hypertension, who was brought to our center after she collapsed while giving a graduation speech. Reverse takotsubo was a presumed diagnosis after we ruled out other differentials. Clinical discussion The pathophysiology of reverse takotsubo syndrome is poorly understood. It might be due to a different pattern of catecholamine-mediated myocardial dysfunction than classic takotsubo cardiomyopathy. It is often associated with physical and/or emotional stressors. Conclusion Supportive treatment and identification and prevention of triggers can reduce the recurrence of reverse takotsubo cardiomyopathy. Physicians should be aware of various triggers for this condition.
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11
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Yadav CP, Dhakal S, Bhattarai HB, Bhattarai M, Lamichhane S, Singh I, Subedi P. Traumatic retroclival hematoma complicated with hyponatremia and delayed traumatic intracranial hematoma in an adult: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231178400. [PMID: 37325171 PMCID: PMC10265364 DOI: 10.1177/2050313x231178400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 05/10/2023] [Indexed: 06/17/2023] Open
Abstract
Intracranial hematoma is a common variety of brain insults in trauma. However, posterior fossa hematoma in the retroclival location is quite unusual. There are limited numbers of case reports regarding traumatic retroclival hematoma. Some are managed with surgery in this condition. We present a traumatic retroclival hematoma in a 34-year-old gentleman who sustained brain trauma in a motor vehicle accident. His condition was further complicated by hyponatremia and delayed traumatic intracerebral hematoma in a distant location. The only symptom he had later was severe headache which could be attributed to delayed traumatic intracerebral hematoma and hyponatremia. He was managed conservatively and discharged on the 12th day from the hospital.
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Affiliation(s)
| | - Sudan Dhakal
- Department of Neurosurgery, Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal
| | | | | | - Saral Lamichhane
- Gandaki Medical College Teaching Hospital & Research Center, Pokhara, Nepal
| | - Ishani Singh
- Kathmandu Medical College, Teaching Hospital and Research Center, Kathmandu, Nepal
| | - Prativa Subedi
- KIST Medical College & Teaching Hospital, Lalitpur, Nepal
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12
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Gautam S, Lamichhane S, Sharma NR, KC P, Basnet A, Kansakar S, Pokhrel M, Shetty V, Moskovits N. Use of midodrine in heart failure: a review. Ann Med Surg (Lond) 2023; 85:2808-2813. [PMID: 37363594 PMCID: PMC10289700 DOI: 10.1097/ms9.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/15/2023] [Indexed: 06/28/2023] Open
Abstract
Heart failure is a global health concern, affecting millions of individuals worldwide. Midodrine, an alpha-1 receptor agonist, might be a potential treatment option for patients with heart failure and concurrent hypotension. This review provides a comprehensive summary of the existing literature on the use of midodrine in heart failure patients, focusing on its pharmacology, epidemiology, and public health impact. Guideline-directed medical therapy (GDMT) is essential in heart failure management, but hypotension may limit its initiation or up-titration. Studies have shown that midodrine can improve blood pressure, reduce the need for vasopressor support, and enable the prescription of GDMT in patients who are intolerant to it due to hypotension. However, there are concerns over increased all-cause mortality in some studies, small sample sizes, and nonrandomized study designs in others. Further research, including large-scale randomized controlled trials and long-term follow-up studies, is needed to better understand the risks and benefits of midodrine use in heart failure patients, particularly in relation to GDMT. Clinicians should consider the potential advantages of midodrine against the limited evidence and potential risks before incorporating it into their clinical practice for heart failure treatment.
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Affiliation(s)
| | | | | | - Prabal KC
- Kathmandu Medical College, Kathmandu, Nepal
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13
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Paneru R, Pokhrel M, Lamichhane S, Basnet S, Poudel S, Gautam S, Sharma NR. Kimura disease masquerading tuberculosis: a rare case presentation. Ann Med Surg (Lond) 2023; 85:3079-3081. [PMID: 37363543 PMCID: PMC10289553 DOI: 10.1097/ms9.0000000000000799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/01/2023] [Indexed: 06/28/2023] Open
Abstract
Kimura disease (KD) is an inflammatory disorder characterized by the development of subcutaneous lymphoid masses and regional lymphadenopathy. Due to its rarity and similarity to another disease, the diagnosis is complex. Case presentation Here, the authors present a case of KD in 26-year-old male from Nepal who initially did not respond to antitubercular therapy. Later on, KD was diagnosed based on histopathology. He was followed up in medical outpatient with a good response to corticosteroid therapy. Clinical discussion The diagnosis of KD is quite difficult in low-resource settings. The diagnosis is histopathological. Associated lymphadenopathy may mimic tuberculosis. Many patients respond well to the high-dose of steroid therapy; some might also require surgical excision or chemotherapy. Conclusion Hence, the physician should include KD as a differential when a male in his 20s or 30s presents with a subcutaneous nodular mass in the head and neck.
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Affiliation(s)
| | | | | | - Subash Basnet
- Tribhuvan University Institute of Medicine, Kathmandu, Nepal
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14
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Sharma NR, Sharma B, Lamichhane S, Pokhrel M, Shrestha P. Cervical spondylotic myelopathy presenting as a "pancake enhancement" on MRI of the spinal cord: A case report and review of literature. Clin Case Rep 2023; 11:e7052. [PMID: 36911632 PMCID: PMC9994163 DOI: 10.1002/ccr3.7052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/08/2023] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
Spondylotic myelopathy involves chronic spinal cord compression from degenerative spine changes presenting a myriad of neurological and pain symptoms. We report a case of cervical myelopathy with transverse pancake-like gadolinium enhancement seen on MRI in a 42-year-old gentleman with progressive bilateral upper extremity numbness, tingling, and impaired gait.
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Affiliation(s)
- Nava Raj Sharma
- Department of Internal Medicine Manipal College of Medical Sciences Pokhara Nepal
| | - Bharosa Sharma
- Department of Internal Medicine John H. Stroger Jr. Hospital of Cook County Chicago Illinois USA
| | - Saral Lamichhane
- Department of Internal Medicine Gandaki Medical College Pokhara Nepal
| | - Madalasa Pokhrel
- Department of Internal Medicine Montefiore Medical Center New York City New York USA
| | - Prajwal Shrestha
- Department of Internal Medicine John H. Stroger Jr. Hospital of Cook County Chicago Illinois USA
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15
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Bajracharya N, Lamichhane S, Lamichhane P, Bishowkarma D, Acharya A, Sharma S, Pandit P. Diagnostic Dilemma of Central Nervous System Tuberculosis with Neurocysticercosis and Neurosarcoidosis: A Case Report. JNMA J Nepal Med Assoc 2023; 61:188-191. [DOI: 10.31729/jnma.8043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Multiple ring-enhancing lesions are commonly encountered abnormalities in neuroimaging. There are many differentials for such lesions as infections, neoplasms, vascular lesions, inflammatory and demyelinating conditions, and granulomatous diseases. In developing countries, tuberculoma and neurocysticercosis are the two important etiologies to be considered. This case report illustrates how multiple ring-enhancing lesions can lead to our management in one direction while the true diagnosis remains elusive. A 53-year-old male who presented with a headache was initially diagnosed and treated as neurocysticercosis, then neurosarcoidosis ultimately turned out to be a case of Central Nervous System Tuberculosis on further evaluation. Consideration of only clinical scenarios and neurological imaging can lead to diagnostic inaccuracy, mismanagement and poor outcome, therefore, other supporting lab investigations should be considered for making a correct diagnosis.
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16
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Lamichhane B, Lamichhane S, Shah R, Yadav M, Pant S. Intraosseous lipoma of Calcaneum: A rare incidental finding. Clin Case Rep 2023; 11:e6849. [PMID: 36694648 PMCID: PMC9842788 DOI: 10.1002/ccr3.6849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/18/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Intraosseous lipoma is a rare benign lesion of bone. We present a case of an intraosseous lipoma of the calcaneum detected as an incidental finding, as a well-delineated osteolytic lesion with the central area of calcification, on plain radiography. Diagnosis can be done with a computed tomography scan and/or magnetic resonance imaging.
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Affiliation(s)
- Bishesh Lamichhane
- Department of RadiologyNepalese Army Institute of Health SciencesKathmanduNepal
| | | | - Roshan Shah
- Department of RadiologyNepalese Army Institute of Health SciencesKathmanduNepal
| | - Mamata Yadav
- Department of RadiologyNepalese Army Institute of Health SciencesKathmanduNepal
| | - Sujata Pant
- Department of RadiologyNepalese Army Institute of Health SciencesKathmanduNepal
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Sharma NR, Sharma B, Pokhrel M, Gautam S, Lamichhane S. The Dilemma Behind Negative Troponin: A Case Report. Cureus 2023; 15:e34377. [PMID: 36874680 PMCID: PMC9976509 DOI: 10.7759/cureus.34377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/03/2023] Open
Abstract
Acute coronary syndrome remains the primary cause of mortality and morbidity in the United States. Cardiac ischemia is a consequence of an imbalance between oxygen demand and supply. The sensitivity of troponin is above 99% in diagnosing cardiac injury; rare exceptions can occur, however. We present a case of acute coronary syndrome with a negative troponin level, even on repeated testing using different methods at two different centers.
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Affiliation(s)
- Nava R Sharma
- Medicine, Manipal College of Medical Science, Pokhara, NPL
| | - Bharosa Sharma
- Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, USA
| | | | | | - Saral Lamichhane
- Department of Internal Medicine, Gandaki Medical College, Pokhara, NPL
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Jaishi PP, Neupane SK, Joshi K, Shrestha N, Khatri SS, Lamichhane S, Neupane PK. Case report: A case of undiagnosed cannabinoid hyperemesis syndrome in rural part of Nepal. Ann Med Surg (Lond) 2022; 84:104897. [PMID: 36582911 PMCID: PMC9793210 DOI: 10.1016/j.amsu.2022.104897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/08/2022] [Accepted: 11/06/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction and importance: Cannabinoid, a widely used recreational drug worldwide. In Nepal, it is found easily and has multiple used as well as misused as a psychoactive substance. Despite having anti emetic property of Marijuana, chronic use of the substance can lead to cyclic vomiting syndrome due to effect in central nervous system and gastrointestinal system. Case we present a case of 28 year old man presented frequently with severe vomiting and abdominal pain which improved with hot showers and stopping use of cannabinoid. Clinical findings and investigation Patient abdomen was tender but all other physical examinations were within normal limits. His lab investigations were within normal limit except of Total leukocyte count and urine analysis. Intervention and outcome The patient was hospitalized and treated for dehydration, nausea and vomiting, and abdominal pain. The patient was diagnosed with cannabinoid hyperemesis syndrome and was discharged from the hospital two days later with the advice to stop using cannabis completely.
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Affiliation(s)
| | | | - Kusum Joshi
- Department of Medicine, Moonlight Polyclinic Private Limited, Siddhipur, Nepal
| | | | | | | | - Prabhat Kiran Neupane
- Internship at Department of Medicine, Kist Medical College, Kathmandu, Nepal
- Corresponding author.
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Sharma NR, Sharma B, Lamichhane S, Pokhrel M, Shrestha P. A Rare Case Report of Sitagliptin-Induced Angioedema. Cureus 2022; 14:e30077. [PMID: 36381841 PMCID: PMC9640175 DOI: 10.7759/cureus.30077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 11/06/2022] Open
Abstract
Sitagliptin, a dipeptidyl peptidase-4 inhibitor, is used for the treatment of type 2 diabetes mellitus. Sitagliptin-induced angioedema has increased with the simultaneous use of angiotensin receptor blockers and angiotensin-converting enzyme inhibitors. We present a rare case of a 50-year-old female diagnosed with sitagliptin-induced angioedema. On examination, she had both upper and lower lip swelling without any respiratory compromise. On further investigation, her C1 esterase inhibitor level was normal. After stopping sitagliptin, her symptoms resolved. Thus, cautious use of dipeptidyl peptidase-4 inhibitor is advised.
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Lamichhane S, Humagain M, Dawadi A, Koju S. Sagittal Root Position of Maxillary Anterior Teeth in Nepalese Population Using Cone Beam Computed Tomography. Kathmandu Univ Med J (KUMJ) 2022; 20:472-476. [PMID: 37795727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Background There are no radiographic studies in Nepalese population for determination of sagittal root positioning in maxillary anterior teeth. The sagittal root positioning and root angulation plays a vital role for case selection in immediate implant placement. Objective To evaluate, classify and compare sagittal root position between different maxillary anterior teeth. Method A 2-year retrospective study was conducted on 100 patients (53 males and 47 females) who fulfilled the inclusion criteria using cone beam computed tomographic images. The relationship of root of tooth to its alveolar housing were recorded as Class I to IV. In addition, the root angulation relative to the alveolar process was also measured. Result The sagittal root position (SRP) calculated on six maxillary anterior teeth on average was found to be 87.83% for Class I, 6.67% for Class II, 0.67% for Class III and 5.17% for Class IV respectively. The mean root angulation was found to be higher with canines on both side whereas lateral incisors had lesser mean root angulation. Root angulation of maximum teeth were between 10-20 degrees where immediate implant placement is possible. Conclusion Within the limitations of this study, the sagittal root positioning and root angulation in Nepalese population showed a favorable result for immediate implant placement. Maximum teeth were found to be close to the alveolar process with the exception of few teeth.
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Affiliation(s)
- S Lamichhane
- Department of Periodontics, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - M Humagain
- Department of Periodontics, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - A Dawadi
- Post Graduate Resident, Department of Periodontics, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Koju
- Post Graduate Resident, Department of Oral Pathology, Kantipur Dental College and Hospital, Kathmandu, Nepal
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Lamichhane S. Iodine deficiency and thyroid dysfunction: Current scenario in Nepal. Ann Med Surg (Lond) 2022; 82:104673. [PMID: 36148087 PMCID: PMC9486041 DOI: 10.1016/j.amsu.2022.104673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/10/2022] [Indexed: 11/15/2022] Open
Abstract
Iodine deficiency is a major cause of thyroid disorders worldwide. Nepal lies in the endemic area of iodine deficiency which was previously referred to as Himalayan goiter belt, with high prevalence of iodine deficiency disorders including goiter, cretinism and hypothyroidism. With effective implementation of universal salt iodization program, Nepal has a successful public health story to share having drastically reduced the iodine deficiency disorders. Moreover, challenge has appeared with rising number of excess iodine states. Thyroid dysfunction is growing higher and the increasing proportion of hyperthyroidism is particularly concerning. Time has come for us to suitably review the standards of salt iodization and control the increasing number of cases with thyroid dysfunction by the coordinated efforts of all stakeholders, along with sustaining the optimal level of iodine.
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Lamichhane S, Pokhrel A, Sharma NR. Medication non-compliance: A challenge in treating hypertension in Nepal. Ann Med Surg (Lond) 2022; 81:104362. [PMID: 36147085 PMCID: PMC9486534 DOI: 10.1016/j.amsu.2022.104362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 12/01/2022] Open
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Lamichhane S, Pokhrel A, Lamichhane P. Seasonal hyperacute panuveitis: Call for greater attention to Nepal. Ann Med Surg (Lond) 2022; 81:104363. [PMID: 36147187 PMCID: PMC9486550 DOI: 10.1016/j.amsu.2022.104363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 08/11/2022] [Indexed: 11/24/2022] Open
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Dawadi A, Humagain M, Sapkota B, Subba M, Neupane M, Lamichhane S. Crown Lengthening Surgery for Enhancing Restorative Treatment in Esthetic Zone. Kathmandu Univ Med J (KUMJ) 2021; 19:278-281. [PMID: 34819452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
For obtaining adequate retention for restoring cases like subgingival caries or extensive caries that shortens the tooth, short clinical crown, and fractures, it is usually necessary to disclose more tooth structure. Crown lengthening procedure is done to increase the clinical crown length for restorative or esthetic reasons without breaching the biologic width. These procedures are also utilized to improve the appearance and retention of restorations placed within the esthetic zone. We report a case of crown lengthening surgery with an internal bevel gingivectomy which was done in our department without compromising tooth support and esthetics.
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Affiliation(s)
- A Dawadi
- Department of Periodontology and Oral Implantology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - M Humagain
- Department of Periodontology and Oral Implantology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - B Sapkota
- Department of Prosthodontics, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - M Subba
- Department of Periodontology and Oral Implantology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - M Neupane
- Department of Periodontology and Oral Implantology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Lamichhane
- Department of Periodontology and Oral Implantology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Lamichhane S, Humagain M, Subba M, Neupane M, Dawadi A. Necrotizing Stomatitis in Varicella Zoster Infection. Kathmandu Univ Med J (KUMJ) 2020; 18:210-213. [PMID: 33594035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Necrotizing periodontal disease are acute periodontal conditions which can present with simple gingivitis to more complex life threatening condition where it can perforate the skin of cheek. They are found in patients with severe illness, stress and reduced immunity. The prevalence of this whole group of disease is usually very low and is stated frequently as the first manifestation in HIV infection. Herpes zoster, a common dermatological condition is a secondary infection due to re-activation of Varicella zoster virus in a person previously acquiring a chicken pox in his/her lifetime. There are limited scientific literatures citing the occurrence of necrotizing stomatitis in varicella zoster infection. Thus, here we present a detail about a case and management of 46 years old female who had a hospital stay of over 5 days for treatment of Herpes zoster infection of mandibular nerve presented with necrotizing stomatitis lesion within oral cavity.
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Affiliation(s)
- S Lamichhane
- Department of Periodontology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - M Humagain
- Department of Periodontology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - M Subba
- Department of Periodontology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - M Neupane
- Department of Periodontology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - A Dawadi
- Department of Periodontology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Kunwar D, Lamichhane S, Pradhan N, Shrestha B, Khadka S, Gautam K, Risal A. The Study of Burden of Family Caregivers of Patients Living with Psychiatric Disorders in Remote Area of Nepal. Kathmandu Univ Med J (KUMJ) 2020; 18:144-148. [PMID: 33594020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background Family caregivers of psychiatric disorders likely to face burden. There is a paucity of data regarding the caregiver burden in psychiatric disorders in context of Nepal. Objective To study the caregiver burden in families with psychiatric illness and to find association between socio-demographic variables and caregiver burden in families with psychiatric illness. Method This is an analytical cross-sectional study. The participants (n=96) were caregiver of patients visiting outpatient department of two government of Nepal primary health care centers namely, Panchkhal Primary Health Care Center (PHC) Kavre District and Barhabise Health Care Center Sindhupalchowk district. The sample size has been determined by using statistical formula. Family burden assessment schedule (FBIS) was used for the study. Result The majority of the caregivers were females 56.3%. Most of the caregivers were aged below 45 years 54.2%. The large number of participants were single or separated 74%. The mean score of family burden assessment schedule was 27 ± 9.8 (range 0 to 48) with positive rate of 59.4%.Among the objective burden domains disruption of family leisure 61.5% was the most frequently reported burden. The subjective burden was reported in 95%. There were significant differential demographic associations with different domains of caregivers' burden. Conclusion Caregivers of Psychiatric patients experience different kind of burden of care. Our findings highlight the support to the family members to reduce their burden.
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Affiliation(s)
- D Kunwar
- Department of Psychiatry, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Lamichhane
- Medical Officer, Ministry of Health, Kathmandu, Nepal
| | - N Pradhan
- Department of Psychiatry, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - B Shrestha
- Department of Psychiatry, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Khadka
- Department of Psychiatry, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - K Gautam
- Medical Officer, Ministry of Health, Kathmandu, Nepal
| | - A Risal
- Department of Psychiatry, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Subedi S, Lamichhane S, Chhetry M. Study of Infertile Couples Attending a Teaching Hospital in Eastern Nepal. JNMA J Nepal Med Assoc 2016; 55:22-25. [PMID: 27935918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
INTRODUCTION Infertility is a global health issue and a socially destabilizing condition for couples with several stigmas including medical, social, psychological burdens and a marital disharmony. The aim was to study the incidence of infertility in couples attending outdoor of Nobel Medical College and to know the contributing factors among the infertile couples. METHODS A prospective cross-sectional study was carried out in the outpatient department of a teaching hospital July 2015-June 2016, where the incidence of infertility and the contributing factors for the same were evaluated. RESULTS The incidence of infertility in this study was 5.45% and it was dominated by secondary infertility. The most important cause was male factor in 37.39%. Majority of male factor abnormality was due to exposure to heat as these male work abroad in Arabian Countries. CONCLUSIONS The study shows a dominance of secondary infertility and male factor being a major contributor. The most common semen abnormality was oligospermia.
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Affiliation(s)
- S Subedi
- Department of Obstetrics and Gynecology, Nobel Medical College, Biratnagar, Nepal
| | - S Lamichhane
- Department of Obstetrics and Gynecology, Nobel Medical College, Biratnagar, Nepal
| | - M Chhetry
- Department of Obstetrics and Gynecology, Nobel Medical College, Biratnagar, Nepal
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Subedi S, Chhetry M, Lamichhane S. Myomectomy Revisited: Experiences in a Teaching Hospital. JNMA J Nepal Med Assoc 2016; 54:79-81. [PMID: 27935928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
INTRODUCTION Uterine myomas are the most common benign tumors of the female reproductive tract with myomectomy being one of the major modalities of the treatment in our set up. The aim of this study was to share the experiences of open myomectomy from a Teaching Hospital. METHODS A observational study was conducted from a records of myomectomy cases in the department of Obstetrics and Gynaecology at Nobel Medical College teaching Hospital from June 2014- May 2016. RESULTS Total 38 cases of myomectomy were performed during the study period in the women most commong age group being 35-39 years, followed by 30-34. The most common presenting symptoms was abnormal uterine bleeding in 15 (39.47%) followed by mass per abdomen in 10 (26.31%). The most common location of the myoma was intramural followed by subserosal, submucus. Degeneration was also noted in majority of the cases. All the myomectomies were done with Inj Vasopressin injected paracervically except in one case where tourniquet was used. None of the patients had significant post-operative morbidity except fever in the first 24 hours. CONCLUSIONS Abdominal myomectomy is a safe and effective procedure for uterine myomas for infertile women in the past but it should be offered to those desiring for uterine preservation irrespective of age and reproductive status.
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Affiliation(s)
- S Subedi
- Department of Obstetrics and Gynaecology, Nobel Medical College, Biratnagar, Nepal
| | - M Chhetry
- Department of Obstetrics and Gynaecology, Nobel Medical College, Biratnagar, Nepal
| | - S Lamichhane
- Department of Obstetrics and Gynaecology, Nobel Medical College, Biratnagar, Nepal
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Lamichhane S, Yde CC, Mielby LH, Kidmose U, Møller JR, Hammershøj M, Bertram HC. High-Resolution Magic Angle Spinning Studies of Semi-Hard Danbo (30+) Cheese-Impact of Processing Condition and Relation to Sensory Perception. ACTA ACUST UNITED AC 2015. [DOI: 10.1039/9781782622741-00171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Vettukattil R, Lamichhane S, Haukaas T, Moestue S, Bathenz T. MC13-0044 Impact of pre-analytical sample handling on metabolomic studies. Eur J Cancer 2013. [DOI: 10.1016/s0959-8049(13)70156-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Limbu DP, Tajhya RB, Limbu A, Singh PM, Batajoo P, Gurung B, Lamichhane S, Rai B. Neuroleptic malignant syndrome: case report. Nepal Med Coll J 2011; 13:144-146. [PMID: 22364104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Neuroleptic Malignant Syndrome (NMS), a potentially fatal complication of neuroleptic therapy is described. It is found to be associated with a variety of medical and psychiatric conditions. Various risk factors and non specific investigations pathognomic to various medical conditions has been proposed. The mortality and morbidity associated with NMS can be decreased with early recognition, early discontinuation of the neuroleptics and aggressive treatment.
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Affiliation(s)
- D P Limbu
- Department of Psychiatry, Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal.
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Manandhar DN, Chhetri PK, Tiwari R, Lamichhane S. Evaluation of dialysis adequacy in patients under hemodialysis and effectiveness of dialysers reuses. Nepal Med Coll J 2009; 11:107-110. [PMID: 19968150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Reuse of dialysers is being practiced since the start of hemodialysis (HD) service in Nepal, which is cost effective as well as safe. A retrospective study was done in Nepal Medical College and Teaching Hospital. We reviewed case records of the year 2008 and retrieved required data such as pre and post urea, post dialysis weight and ultrafiltration volume from 186 sessions of dialysis of 60 patients. Dialysis sessions were divided into nine groups according to the number of use of dialyser. Out of 60 patients, 40 were male. Mean age of the study population was 45.82 +/- 15.42 yrs (range 18-78). Dialysers were reprocessed manually up to 9 times. Adequacy of dialysis was assessed using single pool Kt/v (spKt/v) and urea reduction rate (URR). Mean pre urea, post urea and spKt/v were 160 +/- 51.2 mg/dL, 71.8 +/- 28.5 mg/dL and 0.95 +/- 0.28 respectively. Mean URR was 54.82 +/- 11.24%. Out of total 186 sessions, spKt/v was > or = 1.2 in only 31 sessions (17.0%). There was no significant difference in mean spKt/v between the groups (p=0.87). When compared between the individual groups e.g. 1st vs. 7th, 1st vs. 8th and 1st vs. 9th, there was no significant difference in spKt/v. Dialysis is inadequate in most of our patients undergoing HD twice a week. Reuse of dialyser is effective in urea clearance and the practice of reuse is cost effective and safe.
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Affiliation(s)
- D N Manandhar
- Hemodialysis Unit, Department of Medicine, Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal.
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Chhetri PK, Manandhar DN, Lamichhane S. Vascular access for hemodialysis in Nepal Medical College and Teaching Hospital. Nepal Med Coll J 2009; 11:111-114. [PMID: 19968151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Good vascular access is an essential component for hemodialysis (HD). Studies in patterns of vascular accesses used for HD are very few. Eighty two (male 55, female 27) patients attending HD unit of Nepal Medical College and Teaching Hospital (NMCTH) over a period of one year were enrolled for the study. Average age was 46.12 years. Seventy four patients (90.0%) were suffering from chronic kidney disease (CKD) 5 and 8 (10.0%) patients had acute renal failure. Initial vascular access used was temporary vascular access in 76 (93.0%) and arteriovenous (AV) fistula in 6 (7.0%) patients. As a first temporary vascular access femoral catheterization was used in 54 (66.0%) patients followed by subclavian and internal jugular vein catheterization in 18 (22.0%) and 4 (5.0%) respectively. Fever was observed in 9 (11.0%) patients with first temporary access. There was no complication in 65 (79.0%) cases. Other complications were poor flow, malposition, infection, thrombosis, aneurysm and self removal of catheter. Only 47 patients were analyzed for the second vascular access. Trends towards use of second vascular access was subclavian and internal jugular vein cannulation in 20 (42.5%) and 10 (21.3%) respectively, AV fistula in 13 (27.7%), and femoral catheterization in 4 (8.5%). Second vascular access was associated with fever in 7 (14.9%) and limb swelling in 1 (2.1%). Temporary vascular access was the most common access to initiate HD in CKD 5. Only 7.0% of the patient had AV fistula to start HD. Femoral vein catheterization was the most commonly used first temporary vascular access. Complications with the vascular accesses were negligible.
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Affiliation(s)
- P K Chhetri
- Hemodialysis Unit, Department of Medicine, Nepal Medical College and Teaching Hospital, Atterkhel, Jorpati, Kathmandu, Nepal.
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Chhetri PK, Manandhar DN, Tiwari R, Lamichhane S. In-center hemodialysis for end stage kidney disease at Nepal Medical College and Teaching Hospital. Nepal Med Coll J 2009; 11:61-63. [PMID: 19769242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
End stage kidney disease (ESKD) is defined by glomerular filtration rate (GFR) less than 5 ml/min. These patients need renal replacement therapy (RRT). Hemodialysis is an established form of RRT. Studies on incenter hemodialysis are very few. Here we would like to present our experience on in-center hemodialysis in Nepal Medical College and Teaching Hospital. Study period was one year (1st Baisakh 2065 to 31st Chaitra 2065). Total 33 patients (23 male, 10 female) were enrolled in the study. Average age was 42.33 +/- 15 years. Hypertension (55.0%), diabetes mellitus (24.0%), chronic glomerulonephritis (15.0%), rapidly progressive glomerulonephritis (3.0%) and others (3.0%) were the causes of ESKD requiring dialysis. Hypotension, hypertension, muscle cramps, chest pain were the common complications observed during dialysis. Average haemoglobin level was 9.44 +/- 1.88 g%. Majority of patients were physically inactive. Blood transfusion was the main modality for correction of anaemia. Approximate cost for one session of hemodialysis was Rs. 2000 (U.S. $.25) and average monthly income of study population was Rs.16312.5 (U.S. $.204) U.S. $1 = NRs.80, (4th May 2009).
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Affiliation(s)
- P K Chhetri
- Hemodialysis Unit, Department of Medicine, Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal.
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Kirkpatrick M, Lamichhane S. Demographic patterns, attitudes and practices of women attending an antenatal clinic in rural Nepal. J Inst Med 1990; 12:37-44. [PMID: 12283775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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