Vitamin B12 deficiency usually presents with megaloblastic anemia, pancytopenia, and neurological symptoms. The cause is usually, nutritional deficiency, increase demand, decrease absorption. This report describes a case with symptoms of apathy and findings suggestive of severe hemolytic anemia, diagnosed with vitamin B12 deficiency. Haemolysis is a rare hematological finding in cases of B12 deficiency, and descriptions of a nutritional vitamin B12 deficiency, without evidence of pernicious anaemia, causing haemolysis, are even scarcer, and this paper was intended to draw physicians’ attention to this rare form of presentation.
{"title":"Severe Haemolytic Anaemia, a Rare Presentation of Nutritional Vitamin B12 Deficiency: A Case Report","authors":"A. Siddiqui","doi":"10.3126/NMJ.V2I1.24556","DOIUrl":"https://doi.org/10.3126/NMJ.V2I1.24556","url":null,"abstract":"Vitamin B12 deficiency usually presents with megaloblastic anemia, pancytopenia, and neurological symptoms. The cause is usually, nutritional deficiency, increase demand, decrease absorption. This report describes a case with symptoms of apathy and findings suggestive of severe hemolytic anemia, diagnosed with vitamin B12 deficiency. Haemolysis is a rare hematological finding in cases of B12 deficiency, and descriptions of a nutritional vitamin B12 deficiency, without evidence of pernicious anaemia, causing haemolysis, are even scarcer, and this paper was intended to draw physicians’ attention to this rare form of presentation.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"343 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75461260","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}
Diabetes mellitus is a global health problem in 21st century. The incidence of diabetes mellitus is in rise and is estimated to be more prevalent in coming years. It is becoming one of the most common non-infectious and non-neoplastic causes of morbidity and mortality. Various complications are associated with diabetes mellitus. With control of blood glucose level, complications of diabetes mellitus can be minimized. In different time frame, different parameters and level have been used to diagnose diabetes. Glycosylated hemoglobin A1c is one of the reliable indicator of chronic hyperglycemia. In 2011, World Health Organization has included HbA1c in the diagnostic criteria. Various methods are used to detect the level of HbA1c. Glycosylated hemoglobin is being used in the management of diabetes mellitus. Various studies have shown its prognostic implication in micro and macrovascular complications. Here we discuss various methods of estimation of HbA1c, various role of HbA1c in the management of Diabetes Mellitus and limitation of the test.
{"title":"Diabetes Mellitus And Glycosylated Hemoglobin A1c","authors":"S. Kc","doi":"10.3126/NMJ.V1I2.21744","DOIUrl":"https://doi.org/10.3126/NMJ.V1I2.21744","url":null,"abstract":"Diabetes mellitus is a global health problem in 21st century. The incidence of diabetes mellitus is in rise and is estimated to be more prevalent in coming years. It is becoming one of the most common non-infectious and non-neoplastic causes of morbidity and mortality. Various complications are associated with diabetes mellitus. With control of blood glucose level, complications of diabetes mellitus can be minimized. In different time frame, different parameters and level have been used to diagnose diabetes. Glycosylated hemoglobin A1c is one of the reliable indicator of chronic hyperglycemia. In 2011, World Health Organization has included HbA1c in the diagnostic criteria. Various methods are used to detect the level of HbA1c. Glycosylated hemoglobin is being used in the management of diabetes mellitus. Various studies have shown its prognostic implication in micro and macrovascular complications. Here we discuss various methods of estimation of HbA1c, various role of HbA1c in the management of Diabetes Mellitus and limitation of the test. ","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"137 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79963936","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 different mood states in our daily life can affect our mental and emotional health. The aim of our study was to explore photoplethysmography to record heart rate variability as a marker of changes in mood states in our daily life.Materials and Methods: Two groups of affective pictures categorized into positive and negative sets were shown to thirty subjects on two different consecutive days with simultaneously recording of heart rate variability for 5 minutes by photoplethysmography technique. Immediately after recording on each day, 0-9 self-assessment scale was used to assess the mood state of the subject after viewing the set of pictures.Results: Sympathetic domains of heart rate variability like low frequency (200.3 ±4.1 vs. 166.7 ±2.8, p<0.05), low- and high frequency ratio (1.45 ± 0.21 vs. 0.55 ± 0.07, p<0.05) and low frequency (55.8 ± 2.9 vs. 38.6 ± 2.8, p<0.05) significantly increased in negative mood state condition as compared to positive mood state condition. High frequency (157.9 ± 3.9 vs. 264.3 ± 5.3, p<0.05) and high frequency (44 ± 2.9 vs. 61.2 ±4.2, p< 0.05) significantly increased in positive mood state condition as compared to negative mood state condition. There was significant increase in heart rate (78 ± 2.99 vs. 73 ± 3.11, p<0.05) in negative mood state as compared to positive mood state.Conclusions: Increase in sympathetic activity during negative mood state and increase in parasympathetic activity during positive mood state measured by photoplethysmography technique validates this easy and noninvasive mental assessment tool to determine different mood states.
{"title":"Heart Rate Variability as a Marker of Changes in Mood State in Daily Life by Photoplethysmography Technique","authors":"S. Deo, Kopila Agrawal, Prem Bhattarai","doi":"10.3126/NMJ.V1I2.21601","DOIUrl":"https://doi.org/10.3126/NMJ.V1I2.21601","url":null,"abstract":"Introduction: The different mood states in our daily life can affect our mental and emotional health. The aim of our study was to explore photoplethysmography to record heart rate variability as a marker of changes in mood states in our daily life.Materials and Methods: Two groups of affective pictures categorized into positive and negative sets were shown to thirty subjects on two different consecutive days with simultaneously recording of heart rate variability for 5 minutes by photoplethysmography technique. Immediately after recording on each day, 0-9 self-assessment scale was used to assess the mood state of the subject after viewing the set of pictures.Results: Sympathetic domains of heart rate variability like low frequency (200.3 ±4.1 vs. 166.7 ±2.8, p<0.05), low- and high frequency ratio (1.45 ± 0.21 vs. 0.55 ± 0.07, p<0.05) and low frequency (55.8 ± 2.9 vs. 38.6 ± 2.8, p<0.05) significantly increased in negative mood state condition as compared to positive mood state condition. High frequency (157.9 ± 3.9 vs. 264.3 ± 5.3, p<0.05) and high frequency (44 ± 2.9 vs. 61.2 ±4.2, p< 0.05) significantly increased in positive mood state condition as compared to negative mood state condition. There was significant increase in heart rate (78 ± 2.99 vs. 73 ± 3.11, p<0.05) in negative mood state as compared to positive mood state.Conclusions: Increase in sympathetic activity during negative mood state and increase in parasympathetic activity during positive mood state measured by photoplethysmography technique validates this easy and noninvasive mental assessment tool to determine different mood states.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"07 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86174314","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}
Sanjay Shrestha, A. Ghimire, Safiur Rahman Ansari, Ashok Adhikari
Introduction: Accurate assessment of fluid status in hemodialysis patients presents a significant challenge. Nephrologists have long relied on dry weight estimation based solely on clinical parameters to decide the ultrafiltration volume for patients with end-stage kidney disease on dialysis. However, this method is far from accurate and many patients recurrently suffer from signs and symptoms of fluid overload or circulatory collapse from overaggressive ultrafiltration. Invasive methods such as measurement of central venous pressure cannot be used routinely. We evaluated the usefulness of inferior vena cava (IVC) diameter measured by handheld ultrasound in the estimation of fluid status in patients before and after hemodialysis. Materials and Methods: Clinical assessment included patients’ symptoms, weight, blood pressure, heart rate, and presence of edema before and after dialysis session. Dry weight was assessed based on the above parameters. Each patient underwent measurement of inferior vena cava before and after hemodialysis. The anteroposterior IVC diameter (IVCD) was measured 1.5 cm below the diaphragm in the hepatic segment in supine position during normal inspiration and expiration.Results: Thirty hemodialysis patients (mean age 51.6±18.03 years) were evaluated in outpatient dialysis unit. Following hemodialysis mean IVCe (IVC diameter in expiration) decreased from 1.40±0.38 to 0.91±0.30 cm (p<0.001). Similarly, mean IVCi (IVC diameter in inspiration) decreased from 0.67±0.34 to 0.35±0.19 cm (p<0.001). Changes in IVCD were significantly correlated with alterations in body weight following dialysis (p<0.0001). The IVC collapsibility index (IVC-CI, per cent of change in IVC diameter in expiration vs. inspiration) increased significantly from 0.53±0.18 to 0.68±0.18 after dialysis (p=0.002). IVC diameter and IVC-CI clearly reflected alterations in fluid status. Regarding the clinical parameters of fluid status, following hemodialysis, mean heart rate increased from 81.17±5.21 beats per minute to 86.50±7.99, (p=0.003), systolic blood pressure increased from 148.67±26.36 mmHg to 155.00±28.50, (p=0.05), and diastolic blood pressure increased from 78.62±12.74 mmHg to 84.83±14.55, (p<0.001).Conclusions: Our findings support the applicability of IVCD measurement and IVC-CI in the estimation of fluid status in end stage kidney disease patients on hemodialysis. The clinical parameters of fluid status including heart rate, systolic blood pressure, and diastolic blood pressure suggest that significant numbers of patients underwent excess ultrafiltration based on their traditional dry weight calculation. Thus, using IVC parameters before and during hemodialysis might give a better estimation of fluid status of the patient and guide the amount of ultrafiltration to be done.
简介:准确评估血液透析患者的液体状态提出了一个重大挑战。长期以来，肾病学家仅仅依靠临床参数来估计干重来决定终末期肾病透析患者的超滤体积。然而，这种方法远不准确，许多患者经常出现过度过度超滤引起的液体过载或循环衰竭的体征和症状。侵入性方法如测量中心静脉压不能常规使用。我们评估了手持式超声测量下腔静脉(IVC)直径在估计血液透析前后患者液体状态中的有用性。材料与方法:临床评估包括患者透析前后的症状、体重、血压、心率和水肿情况。根据上述参数评定干重。每位患者在血液透析前后均行下腔静脉测量。在正常吸气和呼气时，取仰卧位，在肝段膈下1.5 cm处测量肝段前后静脉内径(IVCD)。结果:对门诊透析患者30例(平均年龄51.6±18.03岁)进行了评价。血液透析后平均IVCe(呼气时IVC直径)由1.40±0.38 cm降至0.91±0.30 cm (p<0.001)。同样，平均IVCi(吸气腔内IVC直径)从0.67±0.34 cm下降到0.35±0.19 cm (p<0.001)。IVCD的改变与透析后体重的改变显著相关(p<0.0001)。透析后IVC溃散指数(IVC- ci，呼气时与吸气时IVC直径变化百分比)由0.53±0.18显著增加至0.68±0.18 (p=0.002)。下腔静脉内径和下腔静脉-内径清晰地反映了流体状态的变化。血液透析后，患者平均心率由81.17±5.21次/分上升至86.50±7.99次/分(p=0.003)，收缩压由148.67±26.36 mmHg上升至155.00±28.50 mmHg (p=0.05)，舒张压由78.62±12.74 mmHg上升至84.83±14.55 mmHg (p<0.001)。结论:我们的研究结果支持IVCD测量和IVC-CI在评估终末期肾脏疾病血液透析患者体液状态方面的适用性。包括心率、收缩压和舒张压在内的体液状态的临床参数表明，基于传统的干重计算，大量患者进行了过量的超滤。因此，在血液透析前和透析过程中使用IVC参数可以更好地估计患者的液体状态，并指导超滤的量。
{"title":"Use of Handheld Ultrasound to Estimate Fluid Status of Hemodialysis Patients","authors":"Sanjay Shrestha, A. Ghimire, Safiur Rahman Ansari, Ashok Adhikari","doi":"10.3126/NMJ.V1I2.21584","DOIUrl":"https://doi.org/10.3126/NMJ.V1I2.21584","url":null,"abstract":"Introduction: Accurate assessment of fluid status in hemodialysis patients presents a significant challenge. Nephrologists have long relied on dry weight estimation based solely on clinical parameters to decide the ultrafiltration volume for patients with end-stage kidney disease on dialysis. However, this method is far from accurate and many patients recurrently suffer from signs and symptoms of fluid overload or circulatory collapse from overaggressive ultrafiltration. Invasive methods such as measurement of central venous pressure cannot be used routinely. We evaluated the usefulness of inferior vena cava (IVC) diameter measured by handheld ultrasound in the estimation of fluid status in patients before and after hemodialysis. Materials and Methods: Clinical assessment included patients’ symptoms, weight, blood pressure, heart rate, and presence of edema before and after dialysis session. Dry weight was assessed based on the above parameters. Each patient underwent measurement of inferior vena cava before and after hemodialysis. The anteroposterior IVC diameter (IVCD) was measured 1.5 cm below the diaphragm in the hepatic segment in supine position during normal inspiration and expiration.Results: Thirty hemodialysis patients (mean age 51.6±18.03 years) were evaluated in outpatient dialysis unit. Following hemodialysis mean IVCe (IVC diameter in expiration) decreased from 1.40±0.38 to 0.91±0.30 cm (p<0.001). Similarly, mean IVCi (IVC diameter in inspiration) decreased from 0.67±0.34 to 0.35±0.19 cm (p<0.001). Changes in IVCD were significantly correlated with alterations in body weight following dialysis (p<0.0001). The IVC collapsibility index (IVC-CI, per cent of change in IVC diameter in expiration vs. inspiration) increased significantly from 0.53±0.18 to 0.68±0.18 after dialysis (p=0.002). IVC diameter and IVC-CI clearly reflected alterations in fluid status. Regarding the clinical parameters of fluid status, following hemodialysis, mean heart rate increased from 81.17±5.21 beats per minute to 86.50±7.99, (p=0.003), systolic blood pressure increased from 148.67±26.36 mmHg to 155.00±28.50, (p=0.05), and diastolic blood pressure increased from 78.62±12.74 mmHg to 84.83±14.55, (p<0.001).Conclusions: Our findings support the applicability of IVCD measurement and IVC-CI in the estimation of fluid status in end stage kidney disease patients on hemodialysis. The clinical parameters of fluid status including heart rate, systolic blood pressure, and diastolic blood pressure suggest that significant numbers of patients underwent excess ultrafiltration based on their traditional dry weight calculation. Thus, using IVC parameters before and during hemodialysis might give a better estimation of fluid status of the patient and guide the amount of ultrafiltration to be done. ","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88558179","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: Gastric carcinoma is leading cause of death world wide including Nepal. The 5 years survival rate of gastric carcinoma (25%) has drastically decreased compared to early gastric cancers (90-90%) hence implying the need for early detection. Atrophic gastritis and intestinal metaplasia are considered as major high-risk factors and is a precancerous lesion along with Helicobacter pylori. This study tries to look at the distribution of atrophy and intestinal metaplasia across age and gender and their occurrence in Helicobacter pylori positive cases.Materials and methods: It is Cross-sectional study of a retrospectively collected data at KIST medical college and GRP poly clinic private limited from April 2008 till March 2018. Total of 10,683 cases were included. The slides were stained with Hematoxilin and Eosin stain and Giemsa stain and evaluated by two pathologists. Statistical analysis was done using SPSS vs 21.Results: Total numbers of cases studied were 10,683 with male to female ratio of 1.04:1. The most common age group of the study was 18-40 years (n=6206; 58.8%). Atrophy was seen in 81 (0.8 %) cases, Intestinal metaplasia in 298 (2.8 %) cases and Helicobacter Pylori was positive in 4459 (42.2%) cases. The incidence of atrophic gastritis was more in H. pylori positive group 54 (0.5%) group where as intestinal metaplasia was more in H. pylori negative 190(1.8%) group.Conclusion: Atrophic gastritis and intestinal metaplasia, high-risk factors for gastric carcinoma, were not the common findings. Atrophic gastritis was seen in 0.8% and intestinal metaplasia was seen in 2.8% of the total study population.
{"title":"Prevalence of High-Risk Groups for Gastric Carcinoma – A Biopsy Finding","authors":"K. Geetika, S. Kc, Purnima Gyawali","doi":"10.3126/NMJ.V1I2.21600","DOIUrl":"https://doi.org/10.3126/NMJ.V1I2.21600","url":null,"abstract":"Introduction: Gastric carcinoma is leading cause of death world wide including Nepal. The 5 years survival rate of gastric carcinoma (25%) has drastically decreased compared to early gastric cancers (90-90%) hence implying the need for early detection. Atrophic gastritis and intestinal metaplasia are considered as major high-risk factors and is a precancerous lesion along with Helicobacter pylori. This study tries to look at the distribution of atrophy and intestinal metaplasia across age and gender and their occurrence in Helicobacter pylori positive cases.Materials and methods: It is Cross-sectional study of a retrospectively collected data at KIST medical college and GRP poly clinic private limited from April 2008 till March 2018. Total of 10,683 cases were included. The slides were stained with Hematoxilin and Eosin stain and Giemsa stain and evaluated by two pathologists. Statistical analysis was done using SPSS vs 21.Results: Total numbers of cases studied were 10,683 with male to female ratio of 1.04:1. The most common age group of the study was 18-40 years (n=6206; 58.8%). Atrophy was seen in 81 (0.8 %) cases, Intestinal metaplasia in 298 (2.8 %) cases and Helicobacter Pylori was positive in 4459 (42.2%) cases. The incidence of atrophic gastritis was more in H. pylori positive group 54 (0.5%) group where as intestinal metaplasia was more in H. pylori negative 190(1.8%) group.Conclusion: Atrophic gastritis and intestinal metaplasia, high-risk factors for gastric carcinoma, were not the common findings. Atrophic gastritis was seen in 0.8% and intestinal metaplasia was seen in 2.8% of the total study population.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"88 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84138630","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: Skin tumor incidence has increased over the last several decades. A wide range of tumors are encountered in clinical practice. Accurate identification of skin lesions is vital in ensuring malignancies are not missed and that they are treated early to avoid morbidity and mortality.Materials and Methods: A retrospective cross sectional hospital based study on a series of cases was performed in the Department of Pathology, Patan Academy of Health Sciences, Patan Hospital, Lalitpur, Nepal from April 2011 to March 2016. Data from the histopathology database were analyzed using SPSS version 16.0.Results: During the study period, 410 skin biopsies were received, of which 214 (52.2%) were skin neoplasms. Among them, 175 (81.8%) were benign and 39 (18.2%) were malignant neoplasms. Incidence of keratinocytic tumors was highest followed by soft tissue tumors and melanocytic tumors. Intradermal nevus was the most common benign neoplasm. Among the malignant neoplasms, squamous cell carcinoma was most prevalent (46.1%) followed by basal cell carcinoma (15.3%). Skin neoplasms were present in all age groups with maximum number of benign neoplasms prevalent in 21-30 years and malignant in 51-60 years age group. Mean age was 38 years and 58 years for benign and malignant neoplasms respectively.Conclusions: Histopathological evaluation of skin biopsy is an important tool in diagnosis of skin neoplasms. Intradermal nevus and squamous cell carcinoma was the most common benign and malignant neoplasm respectively. Malignant neoplasms were more common in older patients.
{"title":"Histopathological Evaluation of Skin Neoplasms","authors":"P. Sherpa, S. Kc","doi":"10.3126/NMJ.V1I2.21591","DOIUrl":"https://doi.org/10.3126/NMJ.V1I2.21591","url":null,"abstract":"Introduction: Skin tumor incidence has increased over the last several decades. A wide range of tumors are encountered in clinical practice. Accurate identification of skin lesions is vital in ensuring malignancies are not missed and that they are treated early to avoid morbidity and mortality.Materials and Methods: A retrospective cross sectional hospital based study on a series of cases was performed in the Department of Pathology, Patan Academy of Health Sciences, Patan Hospital, Lalitpur, Nepal from April 2011 to March 2016. Data from the histopathology database were analyzed using SPSS version 16.0.Results: During the study period, 410 skin biopsies were received, of which 214 (52.2%) were skin neoplasms. Among them, 175 (81.8%) were benign and 39 (18.2%) were malignant neoplasms. Incidence of keratinocytic tumors was highest followed by soft tissue tumors and melanocytic tumors. Intradermal nevus was the most common benign neoplasm. Among the malignant neoplasms, squamous cell carcinoma was most prevalent (46.1%) followed by basal cell carcinoma (15.3%). Skin neoplasms were present in all age groups with maximum number of benign neoplasms prevalent in 21-30 years and malignant in 51-60 years age group. Mean age was 38 years and 58 years for benign and malignant neoplasms respectively.Conclusions: Histopathological evaluation of skin biopsy is an important tool in diagnosis of skin neoplasms. Intradermal nevus and squamous cell carcinoma was the most common benign and malignant neoplasm respectively. Malignant neoplasms were more common in older patients.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84445268","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}
Medical journals are unbiased and reliable sources of information. They disseminate knowledge to educate medical practitioners and scientists of new development in different fields of medical science. The state of research and publication in developing countries is primitive, and those that are done fail to compete to be published in reputed international journals. The regional open access journals provide an opportunity to such researchers indisseminating their work. Their work is then recorded and available for other researchers and practitioners for reference.Open access journals are good platform, but it is a tremendous task for journals to survive with the little or no resource. Common sources of revenue are sales of print version and article publication charges which are often inadequate. Survival is hard and journals have to look for other sources such as individual donations and fund from institutions or medical societies. One of such journal is PloS Medicine, which has a reputable presence. These alternative sources of income may not be available for all journals and have to turn to advertisements as a majorsource of revenue. Even some of the reputed traditional, subscription-based journals put advertisements as their reliable source of income.
{"title":"Advertisement in Medical Journal – To Be or Not To Be!","authors":"N. Basnet","doi":"10.3126/NMJ.V1I2.21745","DOIUrl":"https://doi.org/10.3126/NMJ.V1I2.21745","url":null,"abstract":"Medical journals are unbiased and reliable sources of information. They disseminate knowledge to educate medical practitioners and scientists of new development in different fields of medical science. The state of research and publication in developing countries is primitive, and those that are done fail to compete to be published in reputed international journals. The regional open access journals provide an opportunity to such researchers indisseminating their work. Their work is then recorded and available for other researchers and practitioners for reference.Open access journals are good platform, but it is a tremendous task for journals to survive with the little or no resource. Common sources of revenue are sales of print version and article publication charges which are often inadequate. Survival is hard and journals have to look for other sources such as individual donations and fund from institutions or medical societies. One of such journal is PloS Medicine, which has a reputable presence. These alternative sources of income may not be available for all journals and have to turn to advertisements as a majorsource of revenue. Even some of the reputed traditional, subscription-based journals put advertisements as their reliable source of income.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88827186","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: Endovascular ablation of varicose vein either by radiofrequency ablationor laser delivers sufficient thermal energy to incompetent vein segments to produce irreversible occlusion, fibrosis and ultimately disappearance of the vein.Materials and Methods: Three hundred patients with varicosities due to primary or recurrent sapheno-femoral or sapheno-popliteal junction and great or small saphenous veinreflux underwent out-patient and in-patient endovenous thermal ablation between January 2015 to December 2017.The great saphenous vein was ablated from 2-2.5 cm below sapheno-femoral junction to knee and the small saphenous vein was ablated from mid-calf to the sapheno-popliteal junction.Results: Patient returning time to normal activity was 0–1 days returning to normal daily activity were immediately after 4 hours. Duplex ultrasound follow-up (median 3-months) confirmed abolition of sapheno-femoral junction/great saphenous vein and sapheno-popliteal junction/small saphenous vein reflux in all limbs. There were no instances of skin burns or deep vein thrombosis, but, 7 patients developed transient cutaneous numbness involving sural nerve and 1 developed endovenous heat induced thrombosis 3.Conclusions: This is likely to be more effective than conventional surgery, although long-term follow up is required. Despite being expensive in comparison to open surgery, endovenous thermal ablation is superior in terms of: minimizing pain, avoiding incision, early mobilisation and discharge. Changing the treatment distance from 2 cm to 2.5 cm peripheral to the Deep veins junction may result in a diminished incidence of endovenous heat induced thrombosis 3.
{"title":"Endovenous Ablation of Varicose Veins Experience at Tertiary Neurological Center","authors":"S. Pandey, G. Katwal, S. Gajuryal","doi":"10.3126/nmj.v1i2.21580","DOIUrl":"https://doi.org/10.3126/nmj.v1i2.21580","url":null,"abstract":"Introduction: Endovascular ablation of varicose vein either by radiofrequency ablationor laser delivers sufficient thermal energy to incompetent vein segments to produce irreversible occlusion, fibrosis and ultimately disappearance of the vein.Materials and Methods: Three hundred patients with varicosities due to primary or recurrent sapheno-femoral or sapheno-popliteal junction and great or small saphenous veinreflux underwent out-patient and in-patient endovenous thermal ablation between January 2015 to December 2017.The great saphenous vein was ablated from 2-2.5 cm below sapheno-femoral junction to knee and the small saphenous vein was ablated from mid-calf to the sapheno-popliteal junction.Results: Patient returning time to normal activity was 0–1 days returning to normal daily activity were immediately after 4 hours. Duplex ultrasound follow-up (median 3-months) confirmed abolition of sapheno-femoral junction/great saphenous vein and sapheno-popliteal junction/small saphenous vein reflux in all limbs. There were no instances of skin burns or deep vein thrombosis, but, 7 patients developed transient cutaneous numbness involving sural nerve and 1 developed endovenous heat induced thrombosis 3.Conclusions: This is likely to be more effective than conventional surgery, although long-term follow up is required. Despite being expensive in comparison to open surgery, endovenous thermal ablation is superior in terms of: minimizing pain, avoiding incision, early mobilisation and discharge. Changing the treatment distance from 2 cm to 2.5 cm peripheral to the Deep veins junction may result in a diminished incidence of endovenous heat induced thrombosis 3.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80693995","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}
S. Pudasaini, B. Joshi, N. Subedi, R. Pathak, Kricha Pande, Shradha Koirala, N. Kafle, K. K. Bhomi, A. Shahi
Primary melanoma of the testis is very rare. Melanoma of testis usually occurs as metastatic tumor. Here we present a case of 54 year old man with right testicular swelling proven to be primary malignant melanoma. Patient had right scrotal swelling of six months duration. With raised LDH and unremarkable Serum β-HCG and Alpha Feto Protein level and with a suscipicion of primary testicular tumor on MRI, right inguinal orchidectomy was done. Its clinical presentation and histopathological examination is discussed here.
{"title":"Primary Melanoma of Testis- A Case Report","authors":"S. Pudasaini, B. Joshi, N. Subedi, R. Pathak, Kricha Pande, Shradha Koirala, N. Kafle, K. K. Bhomi, A. Shahi","doi":"10.3126/NMJ.V1I2.21594","DOIUrl":"https://doi.org/10.3126/NMJ.V1I2.21594","url":null,"abstract":"Primary melanoma of the testis is very rare. Melanoma of testis usually occurs as metastatic tumor. Here we present a case of 54 year old man with right testicular swelling proven to be primary malignant melanoma. Patient had right scrotal swelling of six months duration. With raised LDH and unremarkable Serum β-HCG and Alpha Feto Protein level and with a suscipicion of primary testicular tumor on MRI, right inguinal orchidectomy was done. Its clinical presentation and histopathological examination is discussed here.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"94 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78245102","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: Pulsed carbon dioxide laser devices are considered highly effective treatment options for skin resurfacing. The aim of this study was to evaluate the efficacy and safety of an ablative 10,600-nm carbon dioxide fractional laser system on moderate to severe acne scarsMaterials and Methods: Forty participants (Fitzpatrick skin types III–IV) ranging from the age group of 25-45 who had moderate to severe acne scars were included in the study.CO2 Fractional laser was used, Unit: eCO2 Lutronic Korea; FDA approved, in 3 sessions at one month interval and 4th and 5th sessions at the interval of 2 months. Comparison was done on a monthly basis for the improvement of scars at one monthly interval and any other symptoms like pain, recovery time for wound healing and complications of laser like hyperpigmentation were noted by asking the patient to fill up a questionaire.Results: All the patients completed the treatment.At the end of the session participants experienced a reduction in the size of the scars. At the first laser session, they presented 10-25%, at the second session 20-45% and at the third session 30-60%. All participants felt an ascending improvement rate during and after the course of treatment. An average improvement of 71% was observed. Twelve of sixteen patients showed mild erythema which was transient and recovered at its own.Conclusions: Fractional Co2 laser ablation provides a safe and effective treatment of moderate to severe facial acne.
{"title":"Fractional Ablative Carbondioxide Laser Resurfacing for Acne Scars - A Single Centered Study","authors":"R. Shrestha, A. Karki","doi":"10.3126/NMJ.V1I2.21582","DOIUrl":"https://doi.org/10.3126/NMJ.V1I2.21582","url":null,"abstract":"Introduction: Pulsed carbon dioxide laser devices are considered highly effective treatment options for skin resurfacing. The aim of this study was to evaluate the efficacy and safety of an ablative 10,600-nm carbon dioxide fractional laser system on moderate to severe acne scarsMaterials and Methods: Forty participants (Fitzpatrick skin types III–IV) ranging from the age group of 25-45 who had moderate to severe acne scars were included in the study.CO2 Fractional laser was used, Unit: eCO2 Lutronic Korea; FDA approved, in 3 sessions at one month interval and 4th and 5th sessions at the interval of 2 months. Comparison was done on a monthly basis for the improvement of scars at one monthly interval and any other symptoms like pain, recovery time for wound healing and complications of laser like hyperpigmentation were noted by asking the patient to fill up a questionaire.Results: All the patients completed the treatment.At the end of the session participants experienced a reduction in the size of the scars. At the first laser session, they presented 10-25%, at the second session 20-45% and at the third session 30-60%. All participants felt an ascending improvement rate during and after the course of treatment. An average improvement of 71% was observed. Twelve of sixteen patients showed mild erythema which was transient and recovered at its own.Conclusions: Fractional Co2 laser ablation provides a safe and effective treatment of moderate to severe facial acne.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87285754","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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