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KC M, Bhattarai HB, Subedi P, Kashyap A, Wadhwa M, Kaur D, Koirala S, Gautam S. Renal vein thrombosis in a patient secondary to high-grade rhabdoid renal cell carcinoma: a case report and review of literature. Ann Med Surg (Lond) 2024; 86:2194-2199. [PMID: 38576908 PMCID: PMC10990342 DOI: 10.1097/ms9.0000000000001923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/25/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Renal cell carcinoma, a common kidney tumour which is often incidentally discovered on imaging, can manifest with atypical symptoms. Renal cell carcinoma with rhabdoid features is a rare occurrence and even rarer in case of adults. Renal cell carcinoma has the tendency to form thrombus that can migrate to renal vein, inferior vena cava and even right atrium. Case presentation The authors report a case of an 81-year-old male with rhabdoid renal cell carcinoma presenting with persistent cough for 6-7 months. with tumour thrombus extending into the renal vein and hepatic inferior vena cava. The patient was found feeble for the surgery and hence was treated on anticancer drugs pembrolizumab and axitinib. Conclusion Renal cell carcinoma has the tendency to form tumour thrombus in renal vein and inferior vena cava. Prognosis without surgical intervention in these conditions is very poor.
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Affiliation(s)
- Manish KC
- North Alabama Medical Center, Florence, AL
| | | | - Pratik Subedi
- Nepalese Army Institute of Health Sciences, Tribhuvan University, Sanobharyang
| | - Ashutosh Kashyap
- Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Maharajgunj
| | | | - Dania Kaur
- North Alabama Medical Center, Florence, AL
| | - Sabina Koirala
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
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Bhattarai HB, Yadav J, Sapkota S, Adhikari A, Bhattarai M, Singh I, Shrestha S, KC J, Karki P, Basnet B. Cutaneous drug reaction secondary to antitubercular regimen: A case report from Nepal. SAGE Open Med Case Rep 2023; 11:2050313X231210390. [PMID: 37954539 PMCID: PMC10637153 DOI: 10.1177/2050313x231210390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
Cutaneous adverse drug reactions are known side effects of first-line antitubercular therapy, which ranges from mild pruritus to life-threatening toxic epidermal necrolysis. Severe cutaneous adverse drug reactions can lead to antitubercular therapy discontinuation and further complicates tuberculosis treatment. Here we present the case of a 49-year-old obese male who developed a generalized maculopapular rash within 24 hours of initiation of therapy followed by bullae over palms in 3 days. Antitubercular therapy was immediately discontinued, and he was managed with antihistamines, intravenous fluid, and electrolyte supplementation. He was discharged on antihistamines, a short course of systemic steroids, moxifloxacin, and bedaquiline (second-line antitubercular therapy (ATT)). Proper guidelines about rechallenge therapy will enormously aid in managing cutaneous adverse drug reactions, and efficient treatment of tuberculosis in these patients, and ceasing its progression to multisystemic complications. This article aims to discuss the presentation and management of cutaneous adverse drug reactions in the setting of Nepal.
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Affiliation(s)
| | - Jeshika Yadav
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | - Adarsha Adhikari
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | | | - Ishani Singh
- Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
| | - Sujan Shrestha
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | - Jwala KC
- Nobel Medical College Teaching Hospital, Biratnagar, Nepal
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Katwal S, Oli R, Bhusal A, Bhattarai HB. Partial annular pancreas as an incidental finding in a patient with intermittent bowel obstruction: A case report. Radiol Case Rep 2023; 18:3968-3971. [PMID: 37680665 PMCID: PMC10480449 DOI: 10.1016/j.radcr.2023.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 09/09/2023] Open
Abstract
Complete annular pancreas (AP) is a congenital anomaly, in which the duodenum is either completely or partially encircled by the ring of pancreatic tissue, which eventually becomes continuous with the head of the pancreas. The incidence of AP is estimated to be around 0.02%. Reports from endoscopic retrograde cholangiopancreatography show an incidence of 0.4%. Partial AP (PAP) is a rarer entity, in which a band of pancreatic tissue in continuity with the head of the pancreas, incompletely encircles the duodenum. It may be asymptomatic or may present later in life with complications. We report a case of a 72-years old male with features of intermittent bowel obstruct which was later found to be having PAP on contrast-enhanced computed tomography imaging at the level of renal hilum characterized by "crocodile-jaw appearance." The possibility of PAP should also be considered at the back of mind of the treating physician, if a patient presents with a long-term history of postprandial abdominal discomfort.
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Affiliation(s)
- Shailendra Katwal
- Department of Radiology, Dadeldhura Subregional Hospital, Dadeldhura, Nepal
| | - Rabindra Oli
- Department of Radiology, Nepal Medical College and Teaching Hospital, Nepal
| | - Amrit Bhusal
- Department of Radio-diagnostics and Imaging, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
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Bhattarai HB, Dahal SR, Uprety M, Bhattarai M, Bhattarai A, Oli R, Devkota S, Sah SK, Parajuli S, limbu CP. Bilateral thalamic infarct involving artery of Percheron: a case report. Ann Med Surg (Lond) 2023; 85:4613-4618. [PMID: 37663687 PMCID: PMC10473322 DOI: 10.1097/ms9.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/11/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction and importance The thalamus and the midbrain have marked variations and overlapping in their blood supply; one of those variations is the artery of Percheron. Artery of Percheron occlusion is a rare cause of infarction in the bilateral thalamus and midbrain. Case presentation In this case, a 60-year-old female with chronic hypertension presented with unconsciousness, motor impairments, and oculomotor disorders. Clinical discussion Due to highly variable clinical manifestations and possible negative findings during initial imaging, these conditions are often overlooked, causing delays in therapeutic intervention and leading to bad patient prognosis. Various imaging techniques can be used for diagnosis and treatment should be started early. The treatment aims to promote recanalization as soon as possible and prevent future episodes. The involvement of the midbrain is unfavourable. Conclusion Early clinical assessment and neuroimaging are vital for timely diagnosis and early administration of therapeutic measures for better patient prognosis.
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Affiliation(s)
| | | | - Manish Uprety
- P.T. Birtacity Hospital and Research Center, Birtamod, Jhapa
| | | | - Aseem Bhattarai
- P.T. Birtacity Hospital and Research Center, Birtamod, Jhapa
| | - Rabindra Oli
- P.T. Birtacity Hospital and Research Center, Birtamod, Jhapa
| | - Sijuka Devkota
- P.T. Birtacity Hospital and Research Center, Birtamod, Jhapa
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Bhattarai HB, Basnet B, Bhattarai M, Shrestha A, Gautam S, Lamichhane S, Uprety M, Pokhrel B, Sah SK, Yadav J. Diagnostic pitfalls in young onset parkinsonism and its unique challenges: A case report from rural Nepal. SAGE Open Med Case Rep 2023; 11:2050313X231197062. [PMID: 37663151 PMCID: PMC10474787 DOI: 10.1177/2050313x231197062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023] Open
Abstract
Parkinson's disease is a neurodegenerative disease resulting from the loss of dopamine-secreting neurons present in the substantia nigra of the brain. Parkinson's disease is classified as early-onset and late-onset disease based on the time of its presentation. Since young patients with Parkinson's disease have an atypical clinical presentation and have to deal with their careers, raising families, or both at the time of diagnosis and also have a higher risk of drug-related side effects, it poses unique challenges for the patient, clinical team, and community. We present the case of a 40-year-old female with young onset Parkinson's disease from rural Nepal and the challenges faced during and after the disease in a resource-limited setting.
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Affiliation(s)
| | | | | | - Ayush Shrestha
- Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | | | - Saral Lamichhane
- Gandaki Medical College Teaching Hospital and Research Center Pvt Ltd, Pokhara, Nepal
| | - Manish Uprety
- Kathmandu University School of Medical Sciences, Kathmandu, Nepal
| | - Bidushi Pokhrel
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | | | - Jayant Yadav
- Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
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Bhattarai HB, Thapaliya I, Dhungana S, Singh PB, Bhattarai M, Pokhrel B, Khanal S, Lamichhane S, Gautam S, Basnet B. Unilateral proptosis in a patient with thyroid eye disease: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231190669. [PMID: 37533488 PMCID: PMC10392154 DOI: 10.1177/2050313x231190669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023] Open
Abstract
Unilateral proptosis is an abnormality in which one eye sticks out forward more than the other. Bulging of the eye is commonly seen in Graves' ophthalmopathy, but it's mostly bilateral. Thyroid eye disease presents as the most common extrathyroidal manifestation of Graves' disease, and rarely leads to unilateral proptosis. A 25-year-old female with a history of weight loss, menstrual irregularities, and palpitations presented with progressive right eye bulging, which was further confirmed by magnetic resonance imaging and biochemical investigations. Magnetic resonance imaging of the orbit revealed unilateral extraocular muscle enlargement and enhancement with sparing of the tendons. Timely therapy is crucial for reversing the ocular manifestations of thyroid eye disease.
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Affiliation(s)
| | | | | | | | | | - Bidushi Pokhrel
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Santosh Khanal
- Tribhuvan University, Institute of Medicine, Maharajgunj, Nepal
| | - Saral Lamichhane
- Gandaki Medical College, Teaching Hospital and Research Center, Pokhara, Nepal
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KC P, Bhattarai M, Adhikari S, Parajuli P, Bhandari S, Bhattarai HB, Sharma NK, Karki S, Acharya S, Basnet B. Intestinal tuberculosis can masquerade as Crohn's disease: A teachable moment. SAGE Open Med Case Rep 2023; 11:2050313X231184342. [PMID: 37425137 PMCID: PMC10328157 DOI: 10.1177/2050313x231184342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
Intestinal tuberculosis and Crohn's disease are chronic granulomatous diseases with similar clinical presentations and can mimic one another. Their treatment modalities are completely different; however, sometimes it is challenging to differentiate them. We report a case of a 51-year-old female presenting with abdominal pain and on-and-off diarrhea for 4 years with weight loss. Clinical symptoms along with multiple aphthous ulcers in the terminal ileum and negative tuberculin test favored the diagnosis of Crohn's disease. The patient did not respond to steroids. A repeat colonoscopy with acid-fast bacilli stain showed Mycobacterium tuberculosis. This case highlights that acid-fast bacilli culture and tuberculosis polymerase chain reaction to confirm or rule out the diagnosis of intestinal tuberculosis in all patients suspected of Crohn's disease.
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Affiliation(s)
- Pooja KC
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | | | - Subodh Adhikari
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Prakriti Parajuli
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | | | | | | | - Shailendra Karki
- Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Suryakiran Acharya
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
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Bhattarai HB, Lamichhane S, Bhattarai M, Subedi P, Acharya S, Singh PB, Pandit R, Joshi S, Subedi A, KC M. A case report on agenesis of dorsal pancreas with insulin-dependent diabetes mellitus: a rare entity. Ann Med Surg (Lond) 2023; 85:3626-3629. [PMID: 37427208 PMCID: PMC10328632 DOI: 10.1097/ms9.0000000000000890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/14/2023] [Indexed: 07/11/2023] Open
Abstract
Agenesis of the dorsal pancreas (ADP) is a clinically rare entity that occasionally presents with abdominal pain. It is also association with various disorders of glucose metabolism. Case presentation A 23-year-old male presented with continuous epigastric pain for 4 h and intermittent vomiting. He has a history of experiencing recurrent abdominal pain and diarrhoea for the past 5 years. Additionally, he has been diagnosed with type 1 diabetes mellitus for 15 years. Contrast-enhanced computed tomography of the abdomen showed the absence of body and tail of the pancreas. Discussion ADP is caused by unknown factors, but may be linked to genetic mutations or changes in signalling pathways related to retinoic acid and hedgehog. Symptoms can be absent, but may include abdominal pain, pancreatitis, and hyperglycaemia due to beta-cell dysfunction and insulin deficiency. Imaging modalities, such as contrast tomography or magnetic resonance cholangiopancreatography, or endoscopic retrograde cholangiopancreatography, are crucial in the diagnosis of ADP. Conclusion It is important to consider ADP as a differential diagnosis in patients with glucose metabolism disorders and associated symptoms such as abdominal pain, pancreatitis, or steatorrhea. It requires the combined use of imaging modalities such as ultrasound, contrast tomography, magnetic resonance cholangiopancreatography, or endoscopic retrograde cholangiopancreatography, as ultrasound alone may not provide a complete diagnosis.
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Affiliation(s)
| | - Saral Lamichhane
- Gandaki Medical College, Teaching Hospital and Research Center, Pokhara
| | | | | | | | | | | | | | | | - Manish KC
- Kist Medical College and Teaching Hospital, Lalitpur
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Yadav CP, Dhakal S, Bhattarai HB, Bhattarai M, Lamichhane S, Singh I, Subedi P. Traumatic retroclival hematoma complicated with hyponatremia and delayed traumatic intracranial hematoma in an adult: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231178400. [PMID: 37325171 PMCID: PMC10265364 DOI: 10.1177/2050313x231178400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 05/10/2023] [Indexed: 06/17/2023] Open
Abstract
Intracranial hematoma is a common variety of brain insults in trauma. However, posterior fossa hematoma in the retroclival location is quite unusual. There are limited numbers of case reports regarding traumatic retroclival hematoma. Some are managed with surgery in this condition. We present a traumatic retroclival hematoma in a 34-year-old gentleman who sustained brain trauma in a motor vehicle accident. His condition was further complicated by hyponatremia and delayed traumatic intracerebral hematoma in a distant location. The only symptom he had later was severe headache which could be attributed to delayed traumatic intracerebral hematoma and hyponatremia. He was managed conservatively and discharged on the 12th day from the hospital.
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Affiliation(s)
| | - Sudan Dhakal
- Department of Neurosurgery, Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal
| | | | | | - Saral Lamichhane
- Gandaki Medical College Teaching Hospital & Research Center, Pokhara, Nepal
| | - Ishani Singh
- Kathmandu Medical College, Teaching Hospital and Research Center, Kathmandu, Nepal
| | - Prativa Subedi
- KIST Medical College & Teaching Hospital, Lalitpur, Nepal
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Pokhrel S, Bhusal A, Kumari N, Bhattarai HB, Banjade A. Hepatitis-E-induced cholestasis in a child: a case report. Ann Med Surg (Lond) 2023; 85:3039-3042. [PMID: 37363502 PMCID: PMC10289493 DOI: 10.1097/ms9.0000000000000748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/15/2023] [Indexed: 06/28/2023] Open
Abstract
Hepatitis E virus (HEV) is a major cause of epidemic water-borne hepatitis in tropical and subtropical countries in areas with poor sanitary conditions. The infection by HEV in children is frequent but typically asymptomatic or manifested only as a very mild disease without jaundice, and usually, it often goes undiagnosed. In this case report, the authors describe a case of hepatitis-E-induced cholestasis in a child. Case presentation An 8-year-old male child presented to a Pediatrics emergency with fever and features of acute cholestasis. On abdominal examination, there was non-tender hepatomegaly. The rest of the systemic examinations were normal. Ultrasonography findings were suggestive of acute hepatitis. The liver biopsy report showed hepatic cholestasis and hepatitis. The serological test for hepatitis E IgM was positive. The child was managed symptomatically. Conclusion Although cholestasis is uncommon in children with HEV infection, it should be considered for non-improving clinical status in children with hepatitis. Also, patients with jaundice and Hepatitis E should be followed up by treating physicians until resolution occurs. To the authors' knowledge, this is the first case report from Nepal describing cholestasis in a child due to HEV infection.
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Affiliation(s)
- Sagar Pokhrel
- Department of Pediatrics and Adolescents Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Amrit Bhusal
- Department of Pediatrics and Adolescents Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Neelam Kumari
- Department of Pediatrics and Adolescents Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Himal Bikram Bhattarai
- Department of Pediatrics and Adolescents Medicine, Gandaki Medical College, Teaching Hospital and Research Centre, Pokhara, Nepal
| | - Aneeta Banjade
- Department of Pediatrics and Adolescents Medicine, Gandaki Medical College, Teaching Hospital and Research Centre, Pokhara, Nepal
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Bhattarai HB, Rayamajhi S, Bhattarai M, Bhandari S, Acharya S, Uprety M, Yonghang S, Kadel G, Bhusal S, Joshi S. Salmonella meningitis, an unusual complication of salmonella species: a case report from Nepal. Ann Med Surg (Lond) 2023; 85:2145-2147. [PMID: 37229042 PMCID: PMC10205211 DOI: 10.1097/ms9.0000000000000589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/22/2023] [Indexed: 05/27/2023] Open
Abstract
Salmonella meningitis, caused by a Gram-negative bacillus of the Enterobacteriaceae family, is an uncommon but serious complication of Salmonella infection that can result in high mortality rates, significant neurological damage, and a high relapse rate, and has become a leading cause of Gram-negative bacterial meningitis in the developing world. Case presentation A 16-year-old boy presented with high-grade fever and altered sensorium for 2 days associated with vomiting, headache, and photophobia. Case discussion After invading the abdominal barrier, Salmonella can enter bloodstream and rarely present with meningitis. Cerebrospinal fluid analysis and culture supported with other investigations can diagnose bacterial meningitis and its causative agent. Adequate treatment is essential to completely cure and prevent relapse. Conclusion Given its invasive nature and potential serious consequences, such as relapse and antibiotic resistance, prompt, and appropriate treatment of Salmonella meningitis is essential.
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Affiliation(s)
| | | | | | | | | | - Manish Uprety
- Kathmandu University School of Medical Science, Dhulikhel
| | - Sapana Yonghang
- Gandaki Medical College, Teaching Hospital and Research Center, Pokhara
| | - Gareema Kadel
- Gandaki Medical College, Teaching Hospital and Research Center, Pokhara
| | - Sandhya Bhusal
- Gandaki Medical College, Teaching Hospital and Research Center, Pokhara
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Bhattarai HB, Bhattarai M, Shah S, Singh A, Yadav SK, Yadav BK, Uprety M, Subedi A, Singh PB, Priya A. Meckel's diverticulum causing acute intestinal obstruction: A case series. Clin Case Rep 2022; 10:e6518. [PMCID: PMC9637932 DOI: 10.1002/ccr3.6518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/23/2022] [Accepted: 10/09/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
| | | | - Sangam Shah
- Institute of Medicine Tribhuvan University Maharajgunj Nepal
| | | | | | | | - Manish Uprety
- Kathmandu University of Medical Sciences Kathmandu Nepal
| | - Ayusha Subedi
- Manmohan Memorial and Community Hospital Jhapa Nepal
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13
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Bhattarai HB, Kunwar GJ, Rijal A, Shah S, Uprety M, Subedi A, Singh PB, Khanal S, Shah BB, Rupakheti A. Acute psychosis unveiling diagnosis of hypothyroidism: A case report. Ann Med Surg (Lond) 2022; 82:104565. [PMID: 36268381 PMCID: PMC9577433 DOI: 10.1016/j.amsu.2022.104565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Hypothyroidism is a common condition in the general population that presents a wide array of medical, neurological and psychiatric symptoms. However, hypothyroidism rarely leads to acute psychosis, termed myxedema psychosis (MP) and is often missed by many physicians. Case presentation Here we report a case of a 36-years-old female who presented with a one-week history of abnormal behavior, delusions and hallucinations. Investigations revealed a high thyroid-stimulating-hormone (TSH)of 78.60 mlU/mL and low free thyroxine (FT4) of 0.64 pmol/L. Diagnosed with hypothyroidism, she was treated with oral thyroid hormone replacement (l-thyroxine 75 μg/day) with antipsychotics and her symptoms settled within days. She was discharged off antipsychotics and advised to adhere to thyroxine replacement and to follow up for Thyroid function test (TFT). Discussion Myxedema psychosis is an uncommon manifestation of the common endocrine disease hypothyroidism. The atypical nature of presentations occasionally complicates diagnostics. When approaching a 'first-episode psychosis,’ it is essential to perform a complete organic screen consistently. Conclusion Acute myxedema madness should be considered in the differential diagnosis of acute psychosis in patients with hypothyroidism. Hypothyroidism rarely leads to acute psychosis, termed myxedema psychosis. Acute myxedema madness should be considered in the differential diagnosis of acute psychosis in patients with hypothyroidism. When approaching a 'first-episode psychosis,’ it is essential to perform a complete organic screen consistently.
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Yadav SK, Bhattarai HB, Rijal A, Shrestha A, Shah S, Subedi A, Yadav BK, Acharya A, Khatri R, Kadel G. Duodenal gastrointestinal stromal tumor: A case report. Ann Med Surg (Lond) 2022; 82:104574. [PMID: 36268398 PMCID: PMC9577536 DOI: 10.1016/j.amsu.2022.104574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 11/24/2022] Open
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Bhattarai HB, Chhantyal S, Dahal K, Shah S, Yadav SK, Yadav BK, Subedi A, Baniya S, Singh PB, Priya A. A case report on atypical spindle cell lipomatous tumor: A rare entity. Ann Med Surg (Lond) 2022; 80:104205. [PMID: 36045830 PMCID: PMC9422173 DOI: 10.1016/j.amsu.2022.104205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Atypical spindle cell lipomatous tumor (ASPLT), a separate entity for the group of benign/low grade adipocytic neoplasm that is characterized by adipocyte adequacy and the presence of lipoblast-like cells and spindle cells at varying degrees. Case presentation Here, we report a rare case of 60 years old male with atypical spindle cell lipomatous tumor in the anterior abdominal wall. Discussion Histopathology is the gold standard for establishing the diagnosis and grade of soft tissue tumor and consistent radiology-pathology correlation is essential to avoid any diagnostic pitfalls [1]. Ultrasound is preferred as an initial investigation for superficially located lesions. Conclusion ASPLT show a wide variety of microscopic features, and differential diagnosis is important and difficult. Recognition of morphologic clues and immunohistochemistry/molecular tests to confirm the diagnosis. Histopathology is the gold standard for establishing the diagnosis and grade of soft tissue tumor. Ultrasound is preferred as an initial investigation for superficially located lesions. Atypical spindle cell lipomatous tumor (ASPLT), a separate entity for the group of benign/low grade adipocytic neoplasm.
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Affiliation(s)
| | - Sangit Chhantyal
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | - Krishna Dahal
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | - Sangam Shah
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
- Corresponding author.
| | | | | | - Ayusha Subedi
- Manmohan Memorial and Community Hospital, Jhapa, Nepal
| | - Santosh Baniya
- Gandaki Medical College and Teaching Hospital, Pokhara, Nepal
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Maharjan G, Yadav S, Yadav MK, khati N, Bhattarai HB, Joshi J. Steroid-induced avascular necrosis: A case report on a patient treated with steroid therapy for COVID-19. Ann Med Surg (Lond) 2022; 80:104226. [PMID: 35936570 PMCID: PMC9339079 DOI: 10.1016/j.amsu.2022.104226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/13/2022] [Accepted: 07/19/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction COVID-19 must get a combined approach that involves epidemiology, surveillance, accurate diagnosis, and prophylaxis. Corticosteroids use in the treatment of COVID-19, for a long time at high doses, can cause steroid-induced avascular necrosis. Case report The patient is a 22-year-old female. She came with a complaint of bilateral groin pain for 4 months. The pain was abrupt in onset, continuous, non-radiating, aggravated by walking and relieved with rest. We did an X-ray of the bilateral hips, blood tests, and MRI. With the investigations, we established the diagnosis of avascular necrosis of the femoral head. Discussion Ischemia of the femoral head is caused by any interruption in the blood supply of the acetabulum. It is induced by high-dose and long-term steroid usage. Glucocorticoids affect the metabolism of lipids which results in the formation of fat emboli and lipoprotein globules. This blocks peripheral vessels and leads to necrosis of the bone due to ischemia. Conclusion Avascular necrosis of the femoral head has been reported in patients treated with corticosteroids while being treated for COVID-19. So, physicians should keep it as a possible diagnosis and enhance their knowledge on this topic. COVID-19 treatment also involves the use of corticosteroids. The use of corticosteroids, for a long time at high doses, can cause steroid-induced avascular necrosis. Glucocorticoids affect lipids' metabolism, which further blocks peripheral vessels causing necrosis. Regular screening is required for patients who have received corticosteroids.
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Bhattarai HB, Shah S, Panthi A, Maharjan G, Subedi A, Dhakal R, Koirala A. A case report of anaphylaxis induced by topical use of extract of Cynoglossum wallichii var. golchidiatum. Ann Med Surg (Lond) 2022; 80:104206. [PMID: 36045868 PMCID: PMC9422177 DOI: 10.1016/j.amsu.2022.104206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Case presentation Discussion Conclusion Cyanoglossum wallichii is used as traditional medicine for wounds, burns, and infections. Topical use of Cynoglossum wallichii var. golchidiatum plant's extract over a cut injury causes anaphylaxis.
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Bhattarai HB, Yadav R, Shah S, Uprety M, Subedi A, Singh PB, Devkota A, Panthi N. A case report on role of hypertonic saline solution in management of parotid fistula. Ann Med Surg (Lond) 2022; 80:104208. [PMID: 36045828 PMCID: PMC9422196 DOI: 10.1016/j.amsu.2022.104208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Parotid fistula is an uncommon consequence of surgical or non-surgical trauma to the parotid gland or the area surrounding it. To treat it, a variety of pharmacological medicines and surgical techniques are used, each with their own set of benefits, drawbacks, and patient preferences. Case Presentation We present the successful care of a young female with post-traumatic parotid fistula using hypertonic saline injections into the parotid substance, which is a simple yet efficient approach of treating this abnormality. Discussion Thermodynamic and physicochemical calculations suggest that hypertonic saline solutions work to close parotid fistula by causing conformational denaturation of the cell membrane proteins in situ and saline can be diluted to a point where there will be no cellular toxicity. It is advised that temperature of the saline should be raised above body temperature to enhance the fibrosing property of physiologic saline. Conclusion The use of hypertonic hot saline injections combined with compression dressing is a cost-effective, patient-friendly, and almost complication-free approach of treating parotid fistulas with promising results. Parotid fistula is an uncommon consequence of surgical or non-surgical trauma to the parotid gland. The use of hypertonic hot saline injections is a cost-effective treatment.
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