R. B. Basnet, Prabodh Regmi, Baikuntha Adhikari, B. B. Gharti, S. Basnet, Udita Mishra
Hydatid cyst is a zoonotic disease caused by Echinococcus granulosus, transferred through the oral-fecal pathway by eating vegetables and food contaminated with dog stool containing eggs of the parasite. Hydatid cyst is most commonly found in the liver; however, dissemination can occur in other organs such as the lung and rarely in the heart, breast, thyroid, soft tissue of the neck, and kidney. The surgical approach remains the treatment of choice in hydatid. Meticulous handling of hydatid is important preoperatively and care should be taken against spillage of the contents and daughter cysts. In this case report, we report a case of recurrence of renal hydatidosis.
{"title":"Recurrence of Renal Hydatid Cyst","authors":"R. B. Basnet, Prabodh Regmi, Baikuntha Adhikari, B. B. Gharti, S. Basnet, Udita Mishra","doi":"10.3126/nmj.v5i1.43175","DOIUrl":"https://doi.org/10.3126/nmj.v5i1.43175","url":null,"abstract":"Hydatid cyst is a zoonotic disease caused by Echinococcus granulosus, transferred through the oral-fecal pathway by eating vegetables and food contaminated with dog stool containing eggs of the parasite. Hydatid cyst is most commonly found in the liver; however, dissemination can occur in other organs such as the lung and rarely in the heart, breast, thyroid, soft tissue of the neck, and kidney. The surgical approach remains the treatment of choice in hydatid. Meticulous handling of hydatid is important preoperatively and care should be taken against spillage of the contents and daughter cysts. In this case report, we report a case of recurrence of renal hydatidosis.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84786344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: The characteristics of salivary gland lesions identified by fine-needle aspiration cytology are varied and may overlap, which makes diagnosis difficult for cytopathologists. To provide consistency in the reporting of salivary gland cytology and to enhance clinic-pathologic communication, the "Milan system for reporting salivary gland cytopathology" has been introduced, which offers guidelines for diagnosis and treatment based on various categories of malignancy risk. Material and Methods: In this retrospective study, Fine needle aspiration cytology was done for all salivary gland lesions for three years and were retrieved from the Department of pathology, Patan hospital. All the cases were recategorized according to the Milan system for reporting salivary gland cytology with histopathology follow-up wherever available. Consistency of the two different types of assessment techniques (Milan category and primary cytology diagnosis) were assessed and the k score was calculated Results: A total of 58 cases were included in the study of which histological follow-up was available in 27 cases. Out of 58 cases, maximum cases 32 (55.1%) were classified under IVA followed by 15.5% cases classified under II, 8.6% of cases under Category IVB), 6.8% under category Vand 5.1% cases under category VI. Kappa's score was 0.58 which represents a moderate agreement. Conclusions: Milan system for reporting salivary gland cytopathology is a recently proposed six-category scheme, which places salivary gland fine needle aspiration cytology into well-defined categories that limit the possibilities of false negative and false positive cases.
{"title":"The Milan System for Reporting Salivary Gland Cytopathology: A 3-year Retrospective Analysis in Patan Hospital","authors":"D. Gautam, Rojin Thapa","doi":"10.3126/nmj.v5i1.46793","DOIUrl":"https://doi.org/10.3126/nmj.v5i1.46793","url":null,"abstract":"Introduction: The characteristics of salivary gland lesions identified by fine-needle aspiration cytology are varied and may overlap, which makes diagnosis difficult for cytopathologists. To provide consistency in the reporting of salivary gland cytology and to enhance clinic-pathologic communication, the \"Milan system for reporting salivary gland cytopathology\" has been introduced, which offers guidelines for diagnosis and treatment based on various categories of malignancy risk.\u0000Material and Methods: In this retrospective study, Fine needle aspiration cytology was done for all salivary gland lesions for three years and were retrieved from the Department of pathology, Patan hospital. All the cases were recategorized according to the Milan system for reporting salivary gland cytology with histopathology follow-up wherever available. Consistency of the two different types of assessment techniques (Milan category and primary cytology diagnosis) were assessed and the k score was calculated\u0000Results: A total of 58 cases were included in the study of which histological follow-up was available in 27 cases. Out of 58 cases, maximum cases 32 (55.1%) were classified under IVA followed by 15.5% cases classified under II, 8.6% of cases under Category IVB), 6.8% under category Vand 5.1% cases under category VI. Kappa's score was 0.58 which represents a moderate agreement.\u0000Conclusions: Milan system for reporting salivary gland cytopathology is a recently proposed six-category scheme, which places salivary gland fine needle aspiration cytology into well-defined categories that limit the possibilities of false negative and false positive cases.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83543107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tulsi Ram Shrestha, S. Podar, S. Ghimire, Dhiraj Tamrakar
Introduction: Laryngoscopy and intubation are associated with transient sympathetic responses manifesting as a rise in blood pressure and heart rate. This study was conducted to evaluate the role of oral gabapentin pretreatment in the attenuation of such haemodynamic response. Materials and Methods: Sixty-two patients aged 16 to 60 years weighing 50 to 75 kg undergoing elective surgeries requiring endotracheal intubation were randomized into two groups. group G received 900 mg oral gabapentin and group P received a placebo by mouth two hours before induction of anaesthesia. Patients were induced with propofol, fentanyl, and vecuronium. Laryngoscopy was attempted after four minutes and endotracheal intubation was done. Heart rate, systolic, diastolic, and mean arterial pressure at baseline, before intubation, one, three, five, and ten minutes after intubation were compared between two groups. Patients were observed for any adverse events peri-operatively and post-operatively for the first 24 hours. Results: There was significant attenuation of the rise in blood pressure and heart rate before and after intubation in both groups compared with their corresponding baseline parameters. A significant decrease in heart rate was observed in the gabapentin group only 10 minutes after laryngoscopy and intubation (p=0.022). Conclusions: Oral Gabapentin 900 mg two hours before induction is effective in attenuating the rise in blood pressure and heart rate following laryngoscopy and tracheal intubation, though a statistically significant difference was observed only at 10 minutes after intubation, compared with a placebo group. Besides the significant incidence of pre-induction somnolence, there were no serious perioperative adverse effects.
{"title":"Oral Gabapentin Pretreatment to Attenuate the Haemodynamic Response to Laryngoscopy and Tracheal Intubation","authors":"Tulsi Ram Shrestha, S. Podar, S. Ghimire, Dhiraj Tamrakar","doi":"10.3126/nmj.v5i1.45703","DOIUrl":"https://doi.org/10.3126/nmj.v5i1.45703","url":null,"abstract":"Introduction: Laryngoscopy and intubation are associated with transient sympathetic responses manifesting as a rise in blood pressure and heart rate. This study was conducted to evaluate the role of oral gabapentin pretreatment in the attenuation of such haemodynamic response.\u0000Materials and Methods: Sixty-two patients aged 16 to 60 years weighing 50 to 75 kg undergoing elective surgeries requiring endotracheal intubation were randomized into two groups. group G received 900 mg oral gabapentin and group P received a placebo by mouth two hours before induction of anaesthesia. Patients were induced with propofol, fentanyl, and vecuronium. Laryngoscopy was attempted after four minutes and endotracheal intubation was done. Heart rate, systolic, diastolic, and mean arterial pressure at baseline, before intubation, one, three, five, and ten minutes after intubation were compared between two groups. Patients were observed for any adverse events peri-operatively and post-operatively for the first 24 hours.\u0000Results: There was significant attenuation of the rise in blood pressure and heart rate before and after intubation in both groups compared with their corresponding baseline parameters. A significant decrease in heart rate was observed in the gabapentin group only 10 minutes after laryngoscopy and intubation (p=0.022).\u0000Conclusions: Oral Gabapentin 900 mg two hours before induction is effective in attenuating the rise in blood pressure and heart rate following laryngoscopy and tracheal intubation, though a statistically significant difference was observed only at 10 minutes after intubation, compared with a placebo group. Besides the significant incidence of pre-induction somnolence, there were no serious perioperative adverse effects. ","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88126796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Santosh Kumar Sah, Jay Prakash Singh Rajput, Dimpal Rochlani, R. S. Inamdar
Introduction: Our physical, mental, and emotional well-being require normal sleep. Disturbances in sleep quality and quantity can result in metabolic disorders. Sleep fragmentation increases sympathetic activity which leads to decreased insulin sensitivity. Obstructive sleep apnea causes sleep fragmentation. That is why this study attempt is made to find the effect of obstructive sleep apnea on sleep pattern and blood glucose level in type 2 diabetes patients. Materials and Method: Depending on the severity of the Apnea-Hypopnea Index (AHI) recorded by polysomnography, each, volunteer were divided into two groups, a) AHI>10 groups, and b) AHI≤10 groups. Then the comparison of all the parameters between AHI>10 and AHI≤10 groups of diabetic participants was done. Results: In participants of AHI≤ 10 groups, Sleep efficiency%, Mean TBI SPo2%, sleep Stage III%, and REM% are significantly higher as compared to AHI>10 groups. In participants of the AHI>10 groups, sleep Stage I%, the score of ESS, and fasting blood glucose level are significantly higher as compared to AHI≤ 10 groups. Conclusions: Increasing AHI is associated with reduced sleep efficiency; a sleep stage of N3%, and a REM sleep phase, which lead to an increase in fasting blood glucose levels in the diabetic group.
{"title":"Effect of Obstructive Sleep Apnea on Sleep Pattern and Blood Glucose Level in Type 2 Diabetes Patients","authors":"Santosh Kumar Sah, Jay Prakash Singh Rajput, Dimpal Rochlani, R. S. Inamdar","doi":"10.3126/nmj.v5i1.43223","DOIUrl":"https://doi.org/10.3126/nmj.v5i1.43223","url":null,"abstract":"Introduction: Our physical, mental, and emotional well-being require normal sleep. Disturbances in sleep quality and quantity can result in metabolic disorders. Sleep fragmentation increases sympathetic activity which leads to decreased insulin sensitivity. Obstructive sleep apnea causes sleep fragmentation. That is why this study attempt is made to find the effect of obstructive sleep apnea on sleep pattern and blood glucose level in type 2 diabetes patients.\u0000Materials and Method: Depending on the severity of the Apnea-Hypopnea Index (AHI) recorded by polysomnography, each, volunteer were divided into two groups, a) AHI>10 groups, and b) AHI≤10 groups. Then the comparison of all the parameters between AHI>10 and AHI≤10 groups of diabetic participants was done.\u0000Results: In participants of AHI≤ 10 groups, Sleep efficiency%, Mean TBI SPo2%, sleep Stage III%, and REM% are significantly higher as compared to AHI>10 groups. In participants of the AHI>10 groups, sleep Stage I%, the score of ESS, and fasting blood glucose level are significantly higher as compared to AHI≤ 10 groups.\u0000Conclusions: Increasing AHI is associated with reduced sleep efficiency; a sleep stage of N3%, and a REM sleep phase, which lead to an increase in fasting blood glucose levels in the diabetic group.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75903673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tanvi Meshram, Darshana Rathod, Kamlesh K. Kumari, Arun Sahayraja M
This case is an anesthesia challenge and management of one-lung ventilation in a patient with pulmonary embolism of the ventilated lung. A 50 years old male with a history of pulmonary thromboembolism of segmental and subsegmental branches of the left pulmonary artery was posted for right decortication. He developed hypoxia (sp02~82-85% ) and PaC02-EtCO2 difference of ~30 mm Hg on initiation of one lung ventilation indicating significant shunting of blood and V/Q mismatch. We want to emphasize the importance of intraoperative arterial blood analysis to look for (PaCO2 –EtCO2) difference and periodic reinflation of the collapsed lung for management of patients in whom the blood supply to the dependent is compromised. The presence of pulmonary vascular compromise on the dependent side offers a great number of challenges during the management of one-lung ventilation.
本病例是一例经通气肺栓塞的单肺通气患者的麻醉挑战和处理。一位50岁男性，有左肺动脉节段和亚节段分支的肺血栓栓塞史。单肺通气开始时出现缺氧(sp02~82-85%)， PaC02-EtCO2差~30 mm Hg，提示明显的血液分流和V/Q错配。我们想强调术中动脉血分析的重要性，以寻找(PaCO2 -EtCO2)差异和肺萎陷的周期性再膨胀，以管理患者的血液供应受到损害的依赖。依赖侧肺血管损伤的存在给单肺通气的管理带来了许多挑战。
{"title":"Right-sided Decortication in a Patient with Left Pulmonary Artery Embolism – A Case Report","authors":"Tanvi Meshram, Darshana Rathod, Kamlesh K. Kumari, Arun Sahayraja M","doi":"10.3126/nmj.v5i1.44411","DOIUrl":"https://doi.org/10.3126/nmj.v5i1.44411","url":null,"abstract":"This case is an anesthesia challenge and management of one-lung ventilation in a patient with pulmonary embolism of the ventilated lung. A 50 years old male with a history of pulmonary thromboembolism of segmental and subsegmental branches of the left pulmonary artery was posted for right decortication. He developed hypoxia (sp02~82-85% ) and PaC02-EtCO2 difference of ~30 mm Hg on initiation of one lung ventilation indicating significant shunting of blood and V/Q mismatch. We want to emphasize the importance of intraoperative arterial blood analysis to look for (PaCO2 –EtCO2) difference and periodic reinflation of the collapsed lung for management of patients in whom the blood supply to the dependent is compromised. The presence of pulmonary vascular compromise on the dependent side offers a great number of challenges during the management of one-lung ventilation.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"73 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72716271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Some of the ovarian lesions become functional and secrete hormones that bring endometrial changes like hyperplasias and polyps. This study aimed to find endometrial changes associated with different types of cystic lesions of the ovary. Materials and Methods: A histopathological study done from 2010 -2013 on all the total abdominal hysterectomy specimens with bilateral oophorectomy having cyst size more than 3cms, with a detailed clinical history received in the Department of Pathology, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry. A total of 112 cases were collected analyzed and statistically correlated. Results: Out of the 112 cases of cystic lesions of the ovary 67% showed endometrium within normal limits, 33% of cystic lesions of ovary showed polyps, simple hyperplasia without atypia, complex hyperplasia without atypia. Among non-neoplastic lesions, follicular cyst produced the most endometrial changes, followed by benign surface epithelial lesions. Granulosa cell tumor was found to induce polyp as well as simple hyperplasia without atypia. Two out of three malignant lesions showed endometrial changes followed by benign lesions. The majority of the cystic lesions of the ovary encountered are non-neoplastic lesions (59%) and follicular cysts were more common (97%). Endometrial hyperplasia of both simple and complex types without atypia was found with serous cystadenoma. Conclusions: From the current study it implicates the necessity of assessing cystic lesions of the ovary like a follicular cyst, luteal cyst, granulosa cell tumors as they can become functional leading to endometrial changes that can form a fertile ground for carcinomas.
{"title":"Histopathological Study of Endometrial Changes in Hysterectomy Specimens with Cystic Lesion of Ovary","authors":"P. Pillai","doi":"10.3126/nmj.v4i2.41661","DOIUrl":"https://doi.org/10.3126/nmj.v4i2.41661","url":null,"abstract":"Introduction: Some of the ovarian lesions become functional and secrete hormones that bring endometrial changes like hyperplasias and polyps. This study aimed to find endometrial changes associated with different types of cystic lesions of the ovary.\u0000Materials and Methods: A histopathological study done from 2010 -2013 on all the total abdominal hysterectomy specimens with bilateral oophorectomy having cyst size more than 3cms, with a detailed clinical history received in the Department of Pathology, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry. A total of 112 cases were collected analyzed and statistically correlated.\u0000Results: Out of the 112 cases of cystic lesions of the ovary 67% showed endometrium within normal limits, 33% of cystic lesions of ovary showed polyps, simple hyperplasia without atypia, complex hyperplasia without atypia. Among non-neoplastic lesions, follicular cyst produced the most endometrial changes, followed by benign surface epithelial lesions. Granulosa cell tumor was found to induce polyp as well as simple hyperplasia without atypia. Two out of three malignant lesions showed endometrial changes followed by benign lesions. The majority of the cystic lesions of the ovary encountered are non-neoplastic lesions (59%) and follicular cysts were more common (97%). Endometrial hyperplasia of both simple and complex types without atypia was found with serous cystadenoma.\u0000Conclusions: From the current study it implicates the necessity of assessing cystic lesions of the ovary like a follicular cyst, luteal cyst, granulosa cell tumors as they can become functional leading to endometrial changes that can form a fertile ground for carcinomas.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82852531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heterogeneity of symptoms within and among mild cognitive impairment individuals often makes it challenging to document case reports clinically. Additionally, data on the Indian population is also limited. Therefore, our study includes a case study of a 56-year-old male with mild cognitive impairment from our Institute. A patient had symptoms of mild cognitive impairment following a stroke that occurred 23 years back (vascular in origin). Both formal and informal assessments were carried out. Formal testing was done using the Montreal Cognitive Assessment. On assessment of memory, mild deficits in working memory, episodic memory, and procedural memory were noticed. Attention span and Word-finding difficulties with reduced use of words were observed in language assessment. Problems in reasoning, problem-solving, and decision-making skills, indicating deficits in executive functioning were evident. Linguistic deficits presenting secondary to cognitive deficits in our client could have led to communication breakdowns in speech, affecting his overall quality of life.
{"title":"Speech, Language and Cognitive Profile of Mild Cognitive Impairment: A single Case Study","authors":"Biraj Bhattarai, Joanna K B, P Niranjana, A. B P","doi":"10.3126/nmj.v4i2.38759","DOIUrl":"https://doi.org/10.3126/nmj.v4i2.38759","url":null,"abstract":"Heterogeneity of symptoms within and among mild cognitive impairment individuals often makes it challenging to document case reports clinically. Additionally, data on the Indian population is also limited. Therefore, our study includes a case study of a 56-year-old male with mild cognitive impairment from our Institute. A patient had symptoms of mild cognitive impairment following a stroke that occurred 23 years back (vascular in origin). Both formal and informal assessments were carried out. Formal testing was done using the Montreal Cognitive Assessment. On assessment of memory, mild deficits in working memory, episodic memory, and procedural memory were noticed. Attention span and Word-finding difficulties with reduced use of words were observed in language assessment. Problems in reasoning, problem-solving, and decision-making skills, indicating deficits in executive functioning were evident. Linguistic deficits presenting secondary to cognitive deficits in our client could have led to communication breakdowns in speech, affecting his overall quality of life.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86871876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Basnet, Deepanshu Sharma, Shravya Singh Karki, S. Karki, Hira Lal Bhandari, D. Shrestha
Introduction: The outbreak of coronavirus diseases 2019 (Covid-19) caused by SARS-COV-2 which started in Wuhan china led to an alarming level of spread and severity. In Nepal, the first case of COVID-19 was reported on 23.1.2020 and has become a global health crisis since then. The clinical presentation and outcome of patients with COVID-19 have been variable in different countries and therefore it is important to analyze as well as document the clinical behaviors of this disease in the local population so we have reported the clinic-epidemiological profile, outcome, and its association with conjunctivitis during the second wave of this pandemic which hit Nepal badly hoping this study will be helpful to tackle the future surges of COVID-19 as well. Materials and Methods: This was a prospective, single-center study where the data regarding epidemiology, demography, common clinical presentation as well as management and outcome of COVID-19 Patients were retracted and analyzed. Results: A total of 238 COVID-Positive patients were admitted out of which 60% were male and 39.9% people belonged to Dang valley itself with dyspnea (67.2%) was the commonest symptoms followed by fever in 59.7% of patients. Out of these patients 9 patients presented with ocular symptom conjunctivitis. Conclusions: Mild conjunctivitis manifesting as conjunctival congestion is common and one of the major ocular manifestations in COVID -19 positive patients.
{"title":"Clinico-Demographic Profile of Covid-19 Patients Admitted in COVID- HDU and its Association with Conjunctivitis","authors":"P. Basnet, Deepanshu Sharma, Shravya Singh Karki, S. Karki, Hira Lal Bhandari, D. Shrestha","doi":"10.3126/nmj.v4i2.41492","DOIUrl":"https://doi.org/10.3126/nmj.v4i2.41492","url":null,"abstract":"Introduction: The outbreak of coronavirus diseases 2019 (Covid-19) caused by SARS-COV-2 which started in Wuhan china led to an alarming level of spread and severity. In Nepal, the first case of COVID-19 was reported on 23.1.2020 and has become a global health crisis since then. The clinical presentation and outcome of patients with COVID-19 have been variable in different countries and therefore it is important to analyze as well as document the clinical behaviors of this disease in the local population so we have reported the clinic-epidemiological profile, outcome, and its association with conjunctivitis during the second wave of this pandemic which hit Nepal badly hoping this study will be helpful to tackle the future surges of COVID-19 as well.\u0000Materials and Methods: This was a prospective, single-center study where the data regarding epidemiology, demography, common clinical presentation as well as management and outcome of COVID-19 Patients were retracted and analyzed.\u0000Results: A total of 238 COVID-Positive patients were admitted out of which 60% were male and 39.9% people belonged to Dang valley itself with dyspnea (67.2%) was the commonest symptoms followed by fever in 59.7% of patients. Out of these patients 9 patients presented with ocular symptom conjunctivitis.\u0000Conclusions: Mild conjunctivitis manifesting as conjunctival congestion is common and one of the major ocular manifestations in COVID -19 positive patients.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"285 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75332419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Gautam, R. Ojha, S. Kharel, B. Gajurel, Sanjeeta Sitaula, R. Karn, R. Rajbhandari, A. Shrestha
Introduction: Idiopathic Intracranial Hypertension is characterized by headache, visual impairment, papilledema, and increased cerebrospinal fluid opening pressure. We aim to evaluate clinical manifestations, neuroimaging findings, and treatment of Idiopathic Intracranial Hypertension in a Nepalese tertiary center. Materials and Methods: We retrospectively included patients with the diagnosis of Idiopathic Intracranial Hypertension who were admitted to the Neurology department of Tribhuvan University Teaching Hospital from 2019 June to 2021 May and presented to the Neuro-ophthalmology outpatient clinic of the hospital for follow-up. Results: Out of 16 Idiopathic Intracranial Hypertension patients, 12(75%) patients had either headache or ocular pain. Reduced visual acuity and progressive visual loss were found in 44% of patients. Normal CSF opening pressure was found in 19%, 44% had CSF opening pressure at a range of 20-30 cm H20 and > 30 cm H20 in 37.5%. 15 Idiopathic Intracranial Hypertension patients (93.7%) were subtyped as Typical and 1 patient was diagnosed as Fulminant Idiopathic Intracranial Hypertension. Acetazolamide was used for treatment in 15 patients and 1 patient needed ventriculoperitoneal shunting. 56% Seven patients (44%) had some abnormal findings: partial empty sella (44%), and tortuous optic nerve (31%), flattened posterior eyeball (31%), and hypoplastic transverse sinus (19%). Conclusions: Idiopathic Intracranial Hypertension is an uncommon diagnosis but should be suspected in patients with chronic headaches with visual impairment. In low-resource settings, proper history along with neurological and ophthalmological examinations can even detect the early features and timely referral can save the vision and disability of Idiopathic Intracranial Hypertension patients.
特发性颅内高压以头痛、视力障碍、乳头水肿和脑脊液开口压力升高为特征。我们的目的是评估尼泊尔三级中心特发性颅内高压的临床表现、神经影像学发现和治疗。材料和方法:回顾性纳入2019年6月至2021年5月在特里布万大学教学医院神经内科就诊的特发性颅内高压患者，并在该院神经眼科门诊进行随访。结果:在16例特发性颅内高压患者中，12例(75%)患者出现头痛或眼痛。44%的患者发现视力下降和进行性视力丧失。19%脑脊液开口压力正常，44%脑脊液开口压力在20-30 cm H20范围内，37.5%脑脊液开口压力> 30 cm H20。特发性颅内高压15例(93.7%)亚型为典型，1例诊断为暴发性特发性颅内高压。15例患者使用乙酰唑胺治疗，1例患者需要脑室腹腔分流术。56% 7例(44%)患者有一些异常表现:部分鞍空(44%)，视神经扭曲(31%)，后眼球扁平(31%)，横窦发育不全(19%)。结论:特发性颅内高压是一种罕见的诊断，但在慢性头痛伴视力损害的患者中应予以怀疑。在资源匮乏的环境中，适当的病史配合神经学和眼科检查甚至可以发现早期特征，及时转诊可以挽救特发性颅内高压患者的视力和残疾。
{"title":"Clinical Manifestations, Neuroimaging Findings, and Treatment of Idiopathic Intracranial Hypertension in a Nepalese Tertiary Centre","authors":"N. Gautam, R. Ojha, S. Kharel, B. Gajurel, Sanjeeta Sitaula, R. Karn, R. Rajbhandari, A. Shrestha","doi":"10.3126/nmj.v4i2.40038","DOIUrl":"https://doi.org/10.3126/nmj.v4i2.40038","url":null,"abstract":"Introduction: Idiopathic Intracranial Hypertension is characterized by headache, visual impairment, papilledema, and increased cerebrospinal fluid opening pressure. We aim to evaluate clinical manifestations, neuroimaging findings, and treatment of Idiopathic Intracranial Hypertension in a Nepalese tertiary center.\u0000Materials and Methods: We retrospectively included patients with the diagnosis of Idiopathic Intracranial Hypertension who were admitted to the Neurology department of Tribhuvan University Teaching Hospital from 2019 June to 2021 May and presented to the Neuro-ophthalmology outpatient clinic of the hospital for follow-up.\u0000Results: Out of 16 Idiopathic Intracranial Hypertension patients, 12(75%) patients had either headache or ocular pain. Reduced visual acuity and progressive visual loss were found in 44% of patients. Normal CSF opening pressure was found in 19%, 44% had CSF opening pressure at a range of 20-30 cm H20 and > 30 cm H20 in 37.5%. 15 Idiopathic Intracranial Hypertension patients (93.7%) were subtyped as Typical and 1 patient was diagnosed as Fulminant Idiopathic Intracranial Hypertension. Acetazolamide was used for treatment in 15 patients and 1 patient needed ventriculoperitoneal shunting. 56% Seven patients (44%) had some abnormal findings: partial empty sella (44%), and tortuous optic nerve (31%), flattened posterior eyeball (31%), and hypoplastic transverse sinus (19%).\u0000Conclusions: Idiopathic Intracranial Hypertension is an uncommon diagnosis but should be suspected in patients with chronic headaches with visual impairment. In low-resource settings, proper history along with neurological and ophthalmological examinations can even detect the early features and timely referral can save the vision and disability of Idiopathic Intracranial Hypertension patients.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74661436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Swathi C. Prabhu, A. Tahlan, Shreya Sharma, S. Lehl
Malaria is one of the most common parasitic diseases causing a significant burden on health care, especially in India. Light microscopy, the gold standard for malaria diagnosis is time-consuming especially in a setup where the caseload is high and parasite index is low. Knowledge of abnormal scattergrams by the malarial parasite is very essential to suspect malaria and screen those cases thoroughly on a peripheral smear for accurate diagnosis. A timely and accurate diagnosis is crucial to the prognosis of this disease. Herein, we report a case of a 40-year-old male from Punjab who presented to the emergency with fever and an altered sensorium. Analyzer showed characteristic pseudo eosinophilia with greying of neutrophil eosinophil zone with double eosinophil cluster. According to flagging rules because of eosinophilia, peripheral blood film (PBF) was made and examined, which revealed Plasmodium falciparum gametocytes.
{"title":"Pseudoeosinophilia with Abnormal WBC Scattergram: an Important Diagnostic Clue on Hematology Analyzer","authors":"Swathi C. Prabhu, A. Tahlan, Shreya Sharma, S. Lehl","doi":"10.3126/nmj.v4i2.41920","DOIUrl":"https://doi.org/10.3126/nmj.v4i2.41920","url":null,"abstract":"Malaria is one of the most common parasitic diseases causing a significant burden on health care, especially in India. Light microscopy, the gold standard for malaria diagnosis is time-consuming especially in a setup where the caseload is high and parasite index is low. Knowledge of abnormal scattergrams by the malarial parasite is very essential to suspect malaria and screen those cases thoroughly on a peripheral smear for accurate diagnosis. A timely and accurate diagnosis is crucial to the prognosis of this disease.\u0000Herein, we report a case of a 40-year-old male from Punjab who presented to the emergency with fever and an altered sensorium. Analyzer showed characteristic pseudo eosinophilia with greying of neutrophil eosinophil zone with double eosinophil cluster. According to flagging rules because of eosinophilia, peripheral blood film (PBF) was made and examined, which revealed Plasmodium falciparum gametocytes.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75075611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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