Porencephalic cyst is a fluid filled intracranial lesion, which is usually congenital, but may develop following trauma. CSF rhinorrhoea occurs mostly following trauma and some can present years later, with resulting morbidity and the need for further management . We report an unusual case of post traumatic CSF rhinorrhoea four years after history of trauma. Initial CT scan following trauma was normal and was managed conservatively. Subsequently, patient presented with CSF rhinorrhoea after four years. CT scan showed porencephalic cyst of frontal lobe. CSF leak was managed conservatively and was advised for further neurosurgical intervention. Late onset CSF leak seems to be rare, but important complication of traumatic brain injury.
{"title":"Delayed Presentation of Post-Traumatic Porencephalic Cyst with CSF Rhinorrhoea","authors":"A. Ghimire, G. Shrestha","doi":"10.3126/NMJ.V2I1.24114","DOIUrl":"https://doi.org/10.3126/NMJ.V2I1.24114","url":null,"abstract":"Porencephalic cyst is a fluid filled intracranial lesion, which is usually congenital, but may develop following trauma. CSF rhinorrhoea occurs mostly following trauma and some can present years later, with resulting morbidity and the need for further management . We report an unusual case of post traumatic CSF rhinorrhoea four years after history of trauma. Initial CT scan following trauma was normal and was managed conservatively. Subsequently, patient presented with CSF rhinorrhoea after four years. CT scan showed porencephalic cyst of frontal lobe. CSF leak was managed conservatively and was advised for further neurosurgical intervention. Late onset CSF leak seems to be rare, but important complication of traumatic brain injury.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87945568","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}
Poojyashree Karki, Milesh Jung Sijapati, M. Pandey, N. Khadka
Introduction: High altitude has various effects on human beings. Altitude-related illnesses are a frequent cause of morbidity and occasional mortality in travelers to high altitudes throughout the world. Altitude has potential undesired ophthalmological effects too. Most of these problems are primarily preventable with an adequate level of information before and during travel. In this article, ophthalmological effects like altitude retinopathy and other ocular presentations of high altitude, likely to be encountered by mountaineers, are reviewed.Materials and methods: This is a hospital-based cross-sectional study from March 2016 to March 2017 done in Swacon International Hospital and Sleep Care Center, Kathmandu, Nepal. All the patients diagnosed as acute mountain sickness in the hospital during the study period were included. All the patients were evaluated by a physician and an ophthalmologist. All the findings were recorded in the proforma.Results: A total of 167 patients were admitted. Among them, 98 patients were diagnosed with acute mountain sickness; 20 patients had High altitude cerebral edema and 40 had High altitude pulmonary edema. Ocular findings, among patients who presented to our centre, were a high altitude retinopathy (28.48%) corneal abrasions (5.6%), snow blindness (8.86%), acetazolamide induced myopia (2.53%), conjunctivitis(8.22%), corneal ulcer (1.26%) and retinal detachment(0.63%).Conclusions: Mountaineers are at risk of developing high-altitude-related illnesses. Many other tissues in the eyes are also affected by high-altitude hypoxia, and effects can be observed on the conjunctiva, cornea, intraocular pressure, lens, uvea apart from the retina and the optic nerve.
{"title":"Ocular Presentations in High Altitude Sickness: Experience of Our Centre","authors":"Poojyashree Karki, Milesh Jung Sijapati, M. Pandey, N. Khadka","doi":"10.3126/NMJ.V2I1.23996","DOIUrl":"https://doi.org/10.3126/NMJ.V2I1.23996","url":null,"abstract":"Introduction: High altitude has various effects on human beings. Altitude-related illnesses are a frequent cause of morbidity and occasional mortality in travelers to high altitudes throughout the world. Altitude has potential undesired ophthalmological effects too. Most of these problems are primarily preventable with an adequate level of information before and during travel. In this article, ophthalmological effects like altitude retinopathy and other ocular presentations of high altitude, likely to be encountered by mountaineers, are reviewed.Materials and methods: This is a hospital-based cross-sectional study from March 2016 to March 2017 done in Swacon International Hospital and Sleep Care Center, Kathmandu, Nepal. All the patients diagnosed as acute mountain sickness in the hospital during the study period were included. All the patients were evaluated by a physician and an ophthalmologist. All the findings were recorded in the proforma.Results: A total of 167 patients were admitted. Among them, 98 patients were diagnosed with acute mountain sickness; 20 patients had High altitude cerebral edema and 40 had High altitude pulmonary edema. Ocular findings, among patients who presented to our centre, were a high altitude retinopathy (28.48%) corneal abrasions (5.6%), snow blindness (8.86%), acetazolamide induced myopia (2.53%), conjunctivitis(8.22%), corneal ulcer (1.26%) and retinal detachment(0.63%).Conclusions: Mountaineers are at risk of developing high-altitude-related illnesses. Many other tissues in the eyes are also affected by high-altitude hypoxia, and effects can be observed on the conjunctiva, cornea, intraocular pressure, lens, uvea apart from the retina and the optic nerve.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80972159","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: Systemic Lupus Erythematosus is an autoimmune disease frequently prevalent in women starting from early childhood and towards the reproductive age. Pregnancy with SLE has always imposed great risk both to the mother and the fetus. A multidisciplinary approach with Nephrologist, neonatologist and senior obstetrician during remission leads to a favorable response, through limitation and complications with the use of drugs impose difficulties in their management.Materials and Methods: A prospective, descriptive study was conducted in the Department of Obstetrics and Gynecology and Nephrology at Tribhuvan University Teaching Hospital, for 2 years, from June 2015 to 2017. The study included obstetrical and related complications with outcome in pregnant patients with Systemic Lupus Erythematosus.Results: A total of 19 cases were analyzed of which 15 (79%) had a viable pregnancy and 4 (21%) abortions. Of thirteen cases, 4 (21%) had antiphospholipid antibody syndrome, 8 (42.1%) lupus, and membranous glomerulonephritis and 1 (5.2%) lupus optic neuropathy with loss of vision. All the patients were under drug therapy, like prednisolone, azathioprine, hydroxychloroquine, aspirin, low molecular weight Heparin, tacrolimus, and cyclophosphamide. Only 2 (10.5%) of 19 developed severe pre-eclampsia. There were 12 (80%) term and 3 (20%) each of preterm and intrauterine growth retardation pregnancies with 1 (6.6%) neonatal death (NND) and 1 (5.2%) maternal mortality.Conclusions: Multidisciplinary approach and planned pregnancy reduces the risk of probable complications in the patient resulting to a decreased morbidity and mortality.
{"title":"Systemic Lupus Erythematosus and Pregnancy Outcome in Tertiary Level Hospital of Nepal","authors":"S. Rawal, P. Paudyal, M. Sigdel","doi":"10.3126/NMJ.V2I1.24496","DOIUrl":"https://doi.org/10.3126/NMJ.V2I1.24496","url":null,"abstract":"Introduction: Systemic Lupus Erythematosus is an autoimmune disease frequently prevalent in women starting from early childhood and towards the reproductive age. Pregnancy with SLE has always imposed great risk both to the mother and the fetus. A multidisciplinary approach with Nephrologist, neonatologist and senior obstetrician during remission leads to a favorable response, through limitation and complications with the use of drugs impose difficulties in their management.Materials and Methods: A prospective, descriptive study was conducted in the Department of Obstetrics and Gynecology and Nephrology at Tribhuvan University Teaching Hospital, for 2 years, from June 2015 to 2017. The study included obstetrical and related complications with outcome in pregnant patients with Systemic Lupus Erythematosus.Results: A total of 19 cases were analyzed of which 15 (79%) had a viable pregnancy and 4 (21%) abortions. Of thirteen cases, 4 (21%) had antiphospholipid antibody syndrome, 8 (42.1%) lupus, and membranous glomerulonephritis and 1 (5.2%) lupus optic neuropathy with loss of vision. All the patients were under drug therapy, like prednisolone, azathioprine, hydroxychloroquine, aspirin, low molecular weight Heparin, tacrolimus, and cyclophosphamide. Only 2 (10.5%) of 19 developed severe pre-eclampsia. There were 12 (80%) term and 3 (20%) each of preterm and intrauterine growth retardation pregnancies with 1 (6.6%) neonatal death (NND) and 1 (5.2%) maternal mortality.Conclusions: Multidisciplinary approach and planned pregnancy reduces the risk of probable complications in the patient resulting to a decreased morbidity and mortality.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80943691","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}
Sunita Bhandari, Y. Dwa, Smrity Maskey, M. Bajracharya, Minaxi Thakur
Introduction: With the beginning of comprehensive abortion care service in Nepal, since 2004, safe abortion services in the first trimester are available in all 75 district hospitals of Nepal. Nepal has expanded comprehensive abortion care into the second trimester in 2007. This study tries to investigate the reasons for using comprehensive abortion care service and to know the post-abortion contraceptive acceptance among women presenting at first and second trimester of gestation.Materials and Methods: This hospital-based prospective study was conducted among women seeking comprehensive abortion care service at first and second trimester of gestation in the outpatient department of Obstetrics & Gynaecology, KIST Medical College and Teaching Hospital from July 2017 to July 2018. Data collection was done by filling proforma and was analyzed.Results: There were a total of 171 clients, out of which 78.95% (n=135) were in the first trimester and 21.05% (n=36) in the second trimester of pregnancy. The reason in the first trimester was completed family (39.25%) and the main reason for the second trimester was maternal mental health (48.71%). Among the total study population, 16.37% (n=28) accepted contraception. The most common accepted contraceptive method was implant (n=14; 8.1%), followed by inj. depot medroxyprogesterone acetate (n=8; 4.6%).Conclusions: The prevalence of second-trimester abortion is high despite the availability of first-trimester comprehensive abortion care service. The main reason for induced abortion in first trimester was completed family and in second-trimester was maternal mental health. Post-abortion contraceptive acceptance among comprehensive abortion care clients was very low.
{"title":"An Overview of Comprehensive Abortion Care at Tertiary care Teaching Hospital","authors":"Sunita Bhandari, Y. Dwa, Smrity Maskey, M. Bajracharya, Minaxi Thakur","doi":"10.3126/NMJ.V2I1.24051","DOIUrl":"https://doi.org/10.3126/NMJ.V2I1.24051","url":null,"abstract":"Introduction: With the beginning of comprehensive abortion care service in Nepal, since 2004, safe abortion services in the first trimester are available in all 75 district hospitals of Nepal. Nepal has expanded comprehensive abortion care into the second trimester in 2007. This study tries to investigate the reasons for using comprehensive abortion care service and to know the post-abortion contraceptive acceptance among women presenting at first and second trimester of gestation.Materials and Methods: This hospital-based prospective study was conducted among women seeking comprehensive abortion care service at first and second trimester of gestation in the outpatient department of Obstetrics & Gynaecology, KIST Medical College and Teaching Hospital from July 2017 to July 2018. Data collection was done by filling proforma and was analyzed.Results: There were a total of 171 clients, out of which 78.95% (n=135) were in the first trimester and 21.05% (n=36) in the second trimester of pregnancy. The reason in the first trimester was completed family (39.25%) and the main reason for the second trimester was maternal mental health (48.71%). Among the total study population, 16.37% (n=28) accepted contraception. The most common accepted contraceptive method was implant (n=14; 8.1%), followed by inj. depot medroxyprogesterone acetate (n=8; 4.6%).Conclusions: The prevalence of second-trimester abortion is high despite the availability of first-trimester comprehensive abortion care service. The main reason for induced abortion in first trimester was completed family and in second-trimester was maternal mental health. Post-abortion contraceptive acceptance among comprehensive abortion care clients was very low.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75196603","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}
Health camps or outreach clinics are the effective strategies adopted by both government and non-government organizations, associations, and societies with various interests and scope. A well-organized health camp with a concentration on the various principles of planning, coordination, collaboration, tools, and techniques will not only make the health camp successful but also aids in improving the health status of the unreached community who are often deprived of basic to advance health care facility due to different circumstances.
{"title":"Organizing a Health Camp: Management Perspective","authors":"S. Gajuryal, S. Gautam, Narayan Satyal, B. Pant","doi":"10.3126/NMJ.V2I1.23557","DOIUrl":"https://doi.org/10.3126/NMJ.V2I1.23557","url":null,"abstract":"Health camps or outreach clinics are the effective strategies adopted by both government and non-government organizations, associations, and societies with various interests and scope. A well-organized health camp with a concentration on the various principles of planning, coordination, collaboration, tools, and techniques will not only make the health camp successful but also aids in improving the health status of the unreached community who are often deprived of basic to advance health care facility due to different circumstances.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80836408","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. Pokhrel, N. Rai, R. Pathak, Aajma Thapa, N. Regmi, P. Sharma
Introduction: Alcohol is a legally allowed substance used for recreation associated with harmful health consequences both on using it and trying to quit (withdrawal phase). Many patients of alcohol dependence are brought to hospital or emergency in the withdrawal phase and require intensive treatment. It’s associated with life threatening conditions and associated with occurrences of seizures and confusion. Based on severity, it can be subtyped and managed differently. The study tries to compare and contrast the subtypes of withdrawal phases of alcohol in terms of clinical, outcome and metabolic parametersMaterials and Methods: This is a cross-sectional study of all patients diagnosed as alcohol dependence syndrome admitted over a period of two years (June 2016 to June 2018) in the psychiatric ward of KIST medical college and teaching hospital. It’s divided into two phases namely complicated and uncomplicated phase and clinical, outcome and metabolic parameters are compared and contrasted.Results: Out of 166 patients studied, 54% of the patients were diagnosed with complicated withdrawal features. Significant changes were noticed in increase duration of stay, low level of platelets and potassium and SGPT levels in a complicated group compare to the uncomplicated group. Mortality was not seen in any of the groupConclusions: Patients can be treated in-ward setting successfully and if the diagnosis is of complicated withdrawal then metabolic parameters like potassium, platelet level has to be taken into consideration. Complicated withdrawal features increase the chance of morbidity and increase the duration of stay.
{"title":"A Comparative Study of Clinical Profile, Metabolic Parameters and Outcome of Patient Among Subtypes of Alcohol Dependence Syndrome in Tertiary Level Hospital of Kathmandu Valley","authors":"P. Pokhrel, N. Rai, R. Pathak, Aajma Thapa, N. Regmi, P. Sharma","doi":"10.3126/NMJ.V2I1.24104","DOIUrl":"https://doi.org/10.3126/NMJ.V2I1.24104","url":null,"abstract":"Introduction: Alcohol is a legally allowed substance used for recreation associated with harmful health consequences both on using it and trying to quit (withdrawal phase). Many patients of alcohol dependence are brought to hospital or emergency in the withdrawal phase and require intensive treatment. It’s associated with life threatening conditions and associated with occurrences of seizures and confusion. Based on severity, it can be subtyped and managed differently. The study tries to compare and contrast the subtypes of withdrawal phases of alcohol in terms of clinical, outcome and metabolic parametersMaterials and Methods: This is a cross-sectional study of all patients diagnosed as alcohol dependence syndrome admitted over a period of two years (June 2016 to June 2018) in the psychiatric ward of KIST medical college and teaching hospital. It’s divided into two phases namely complicated and uncomplicated phase and clinical, outcome and metabolic parameters are compared and contrasted.Results: Out of 166 patients studied, 54% of the patients were diagnosed with complicated withdrawal features. Significant changes were noticed in increase duration of stay, low level of platelets and potassium and SGPT levels in a complicated group compare to the uncomplicated group. Mortality was not seen in any of the groupConclusions: Patients can be treated in-ward setting successfully and if the diagnosis is of complicated withdrawal then metabolic parameters like potassium, platelet level has to be taken into consideration. Complicated withdrawal features increase the chance of morbidity and increase the duration of stay.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"73 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86397413","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: Around 25% of the total population in Nepal is adolescents (10 to 19 years old). Nutritional programs in Nepal are targeted to young children and pregnant women but neglected among adolescent. Such approach may result poor nutritional status among them. This will lead to poor health outcome and poor academic performance among school children. Thus we aimed to study the nutritional status assessment of adolescent school children in Solukhumbu.Material and Methods: It was a cross sectional study conducted over a period of two and half months (May-July 2018) in a government school at Salleri, Solukhumbu, Nepal. Study participants are 192 students, both male and female, from the age group 10 to 17 years old. Body Mass Index and Height for age was determined by anthropometry. The interview was done by using structured questionnaires to elicit socio-demographic variables.Results: Among 192 students age 10-17 years old, 122(63.5%) were female and 70(36.5%) were male. The majority was Janajati 160(83.3%), Major religion was Hindu 99(51.6%) and Buddhist 93(43.2%), Agriculture was the major occupation of both parents. The literacy rate of the father is 63.2% and mother is 39.9 percent. The majority are underweight 53(27.6%), overweight 11 (5.7%) and obese 3(1.6%). Median Height for Age was 94 (±6.5) with a minimum of 76 and a maximum of 112 and 99(51.6%) are stunted.Conclusions: Stunting, underweight and overweight were prevalent among adolescent children in the school. The causes of these problems should be identified by doing further research and intervention should be done accordingly.
{"title":"Nutritional Status Assessment of Adolescent School Going Children in Solukhumbu, Nepal","authors":"A. T. Sherpa, Neeti Singh, P. Basnet, M. Sherpa","doi":"10.3126/NMJ.V2I1.24488","DOIUrl":"https://doi.org/10.3126/NMJ.V2I1.24488","url":null,"abstract":"Introduction: Around 25% of the total population in Nepal is adolescents (10 to 19 years old). Nutritional programs in Nepal are targeted to young children and pregnant women but neglected among adolescent. Such approach may result poor nutritional status among them. This will lead to poor health outcome and poor academic performance among school children. Thus we aimed to study the nutritional status assessment of adolescent school children in Solukhumbu.Material and Methods: It was a cross sectional study conducted over a period of two and half months (May-July 2018) in a government school at Salleri, Solukhumbu, Nepal. Study participants are 192 students, both male and female, from the age group 10 to 17 years old. Body Mass Index and Height for age was determined by anthropometry. The interview was done by using structured questionnaires to elicit socio-demographic variables.Results: Among 192 students age 10-17 years old, 122(63.5%) were female and 70(36.5%) were male. The majority was Janajati 160(83.3%), Major religion was Hindu 99(51.6%) and Buddhist 93(43.2%), Agriculture was the major occupation of both parents. The literacy rate of the father is 63.2% and mother is 39.9 percent. The majority are underweight 53(27.6%), overweight 11 (5.7%) and obese 3(1.6%). Median Height for Age was 94 (±6.5) with a minimum of 76 and a maximum of 112 and 99(51.6%) are stunted.Conclusions: Stunting, underweight and overweight were prevalent among adolescent children in the school. The causes of these problems should be identified by doing further research and intervention should be done accordingly.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79518996","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: Intravenous Immunoglobulin is an approved therapy for Guillain Barre Syndrome. Our objective is to understand the management and outcome in Guillain Barre Syndrome patients treated with Immunoglobulin.Materials and Methods: All consecutive patients were retrospectively evaluated in the study were of age ≥16 years and were being admitted in the department of Neurology of Tribhuvan University Teaching Hospital, Kathmandu, Nepal from 2016 March to 2017 February.Results: A total of 46 patients were included, mean age= 36.5±16.2 years, range = 16years to 80 years. Thirty-two patients (70%) were axonal variant, acute motor axonal neuropathy is more common (18 patients). Intravenous immunoglobulin was used in 23 patients (50%), 17 of them were axonal variant and 6 were demyelinating. Guillain Barre Syndrome patients with bilateral facial weakness (70% vs 30%; p<0.05) were likely to receive immunoglobulin therapy. Patients with immunoglobulin were found to have higher ODSS at Nadir (9.3±1.8 vs 6.9±1.9; p <0.001) and discharge than patients without immunoglobulin treatment (6.2±1.7 vs 5.0±1.6; p=0.001). At Nadir, Patients with immunoglobulin were found to have higher Guillain Barre Syndrome disability score (4.1±0.7 vs 3.2±0.9; p<0.095). In immunoglobulin group, Axonal variants were found to havehigher ODSS score (9.6±1.9 vs 8.2±0.9, p=0.027) and Guillain Barre Syndrome disability score (4.2±0.7 vs 3.5±0.5; p=0.019) at nadir than demyelinating group.Conclusions: Intravenous Immunoglobulin is easier to administer and is safe with fewer adverse effects. Although expensive, it is an effective treatment option in a resource-limited center. Axonal variants are clinically severe and likely to be need of Intravenous Immunoglobulin therapy.
静脉注射免疫球蛋白是一种被批准的治疗格林-巴利综合征的药物。我们的目的是了解免疫球蛋白治疗格林-巴利综合征患者的管理和结果。材料和方法:回顾性评估研究中所有连续患者，年龄≥16岁，于2016年3月至2017年2月在尼泊尔加德满都特里布万大学教学医院神经内科住院。结果:共纳入46例患者，平均年龄= 36.5±16.2岁，范围= 16岁~ 80岁。轴突变异性32例(70%)，以急性运动轴突神经病多见(18例)。静脉注射免疫球蛋白23例(50%)，其中轴突变异17例，脱髓鞘6例。格林-巴利综合征患者双侧面部无力(70% vs 30%;P <0.05)均有可能接受免疫球蛋白治疗。免疫球蛋白组患者在Nadir时的ODSS较高(9.3±1.8 vs 6.9±1.9;P <0.001)，出院率高于未接受免疫球蛋白治疗的患者(6.2±1.7 vs 5.0±1.6;p = 0.001)。在最低点，使用免疫球蛋白的患者有更高的格林-巴利综合征残疾评分(4.1±0.7 vs 3.2±0.9;p < 0.095)。免疫球蛋白组轴突变异体的ODSS评分(9.6±1.9 vs 8.2±0.9,p=0.027)和格林-巴利综合征残疾评分(4.2±0.7 vs 3.5±0.5;P =0.019)。结论:静脉注射免疫球蛋白给药简便、安全、不良反应少。虽然昂贵，但在资源有限的中心，这是一种有效的治疗选择。轴突变异在临床上很严重，可能需要静脉注射免疫球蛋白治疗。
{"title":"Clinical Outcome of Intravenous Immunoglobulin in the treatment of Guillain Barre Syndrome in a Nepalese Tertiary Centre","authors":"R. Ojha, R. Karn","doi":"10.3126/NMJ.V2I1.24000","DOIUrl":"https://doi.org/10.3126/NMJ.V2I1.24000","url":null,"abstract":"Introduction: Intravenous Immunoglobulin is an approved therapy for Guillain Barre Syndrome. Our objective is to understand the management and outcome in Guillain Barre Syndrome patients treated with Immunoglobulin.Materials and Methods: All consecutive patients were retrospectively evaluated in the study were of age ≥16 years and were being admitted in the department of Neurology of Tribhuvan University Teaching Hospital, Kathmandu, Nepal from 2016 March to 2017 February.Results: A total of 46 patients were included, mean age= 36.5±16.2 years, range = 16years to 80 years. Thirty-two patients (70%) were axonal variant, acute motor axonal neuropathy is more common (18 patients). Intravenous immunoglobulin was used in 23 patients (50%), 17 of them were axonal variant and 6 were demyelinating. Guillain Barre Syndrome patients with bilateral facial weakness (70% vs 30%; p<0.05) were likely to receive immunoglobulin therapy. Patients with immunoglobulin were found to have higher ODSS at Nadir (9.3±1.8 vs 6.9±1.9; p <0.001) and discharge than patients without immunoglobulin treatment (6.2±1.7 vs 5.0±1.6; p=0.001). At Nadir, Patients with immunoglobulin were found to have higher Guillain Barre Syndrome disability score (4.1±0.7 vs 3.2±0.9; p<0.095). In immunoglobulin group, Axonal variants were found to havehigher ODSS score (9.6±1.9 vs 8.2±0.9, p=0.027) and Guillain Barre Syndrome disability score (4.2±0.7 vs 3.5±0.5; p=0.019) at nadir than demyelinating group.Conclusions: Intravenous Immunoglobulin is easier to administer and is safe with fewer adverse effects. Although expensive, it is an effective treatment option in a resource-limited center. Axonal variants are clinically severe and likely to be need of Intravenous Immunoglobulin therapy.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80874257","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}
{"title":"Artificial Intelligence in Pathology and Medicine","authors":"G. Kc","doi":"10.3126/NMJ.V2I1.24644","DOIUrl":"https://doi.org/10.3126/NMJ.V2I1.24644","url":null,"abstract":"No abstract available.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"21 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85434992","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. K. Choudhary, N. Nepal, N. Mainali, Gaurav Chhetri
Introduction: Lymphadenopathy is a very common condition for which excision biopsy is often recommended when fine needle aspiration cytology is not conclusive. Lymph node imprint cytology is a useful and rapid alternative diagnostic tool. This study was conducted to assess the accuracy of lymph node imprint cytology as compared to the histopathology.Materials and Methods: Imprint smears were made from all cases of lymphadenopathy. The smears were evaluated by three pathologists and categorized into, inflammatory lesions and primary and metastatic tumors. Imprint smears were made from lymph node excision specimens and were stained with PAP and MGG stains. The diagnosis in imprints was compared with those given by histopathology. With the help of sensitivity, specificity & accuracy, the agreement between the imprint smear and histopathology was determined.Results: Among the total 92 cases, 40 (43.4%) cases were chronic non-specific lymphadenitis, 22 (23.9%) were tuberculosis and metastatic lesions each. The overall accuracy of lymph node imprint cytology was 96.73%, 96.74%, 96.74% and 100% for tuberculosis, chronic non-specific lymphadenitis, lymphoma, and metastatic lesions respectively.Conclusions: Lymph node imprint smears is a rapid diagnostic tool and can be used routinely as an adjunct to histopathology in the diagnosis of various lymph node disorders.
{"title":"Diagnostic Role of Lymphnode Imprint: A Cyto-histopathological Correlation","authors":"P. K. Choudhary, N. Nepal, N. Mainali, Gaurav Chhetri","doi":"10.3126/NMJ.V2I1.24053","DOIUrl":"https://doi.org/10.3126/NMJ.V2I1.24053","url":null,"abstract":"Introduction: Lymphadenopathy is a very common condition for which excision biopsy is often recommended when fine needle aspiration cytology is not conclusive. Lymph node imprint cytology is a useful and rapid alternative diagnostic tool. This study was conducted to assess the accuracy of lymph node imprint cytology as compared to the histopathology.Materials and Methods: Imprint smears were made from all cases of lymphadenopathy. The smears were evaluated by three pathologists and categorized into, inflammatory lesions and primary and metastatic tumors. Imprint smears were made from lymph node excision specimens and were stained with PAP and MGG stains. The diagnosis in imprints was compared with those given by histopathology. With the help of sensitivity, specificity & accuracy, the agreement between the imprint smear and histopathology was determined.Results: Among the total 92 cases, 40 (43.4%) cases were chronic non-specific lymphadenitis, 22 (23.9%) were tuberculosis and metastatic lesions each. The overall accuracy of lymph node imprint cytology was 96.73%, 96.74%, 96.74% and 100% for tuberculosis, chronic non-specific lymphadenitis, lymphoma, and metastatic lesions respectively.Conclusions: Lymph node imprint smears is a rapid diagnostic tool and can be used routinely as an adjunct to histopathology in the diagnosis of various lymph node disorders.","PeriodicalId":52856,"journal":{"name":"Nepalese Medical Journal","volume":"1991 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82338007","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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