Traumatic Abdominal wall hernia with ileal perforation following blunt trauma abdomen: A rare case report and review of literature

Blunt trauma abdomen with abdominal wall herniation with bowel perforation is an acute emergency condition. Road traffic accidents causing blunt trauma are common in a youngster like in our case. Once the patient is resuscitated, ultrasonography and Computed tomography must be done. Early surgical exploration with mesh or primary repair of the defect is the mainstay of management. We have a case of a 25-year-old male with blunt trauma abdomen and anterior wall hernia following a road traffic accident who was managed with emergency exploratory laparotomy as computed tomography suggested anterior abdominal wall herniation of bowel content.

Asymptomatic spontaneous expulsion of a long foreign body through the gastrointestinal tract - a curious case report

Foreign body ingestion and its natural elimination are common in children. However, this is uncommon for long foreign bodies. Here, we report the spontaneous removal of an ingested pencil in an asymptomatic child. To our knowledge, this is the first case report of asymptomatic spontaneous elimination of a normally-sized ingested pencil. A 7-year-old male child presented with a history of ingestion of a pencil 4 hours back, without any complaints. Immediate abdominal radiography revealed a pencil in the stomach with an estimated length of approximately 10 cm and no signs of complications. He was conservatively treated under a semi-solid diet, presumably due to lack of available endoscopic option. Subsequently, he passed the pencil in stool within 24 hours of ingestion. He was asymptomatic and playful during the course and at discharge. Conservative management of a quickly moving long foreign body initially located below the esophagus in an asymptomatic child is possible with the help of imaging guidance, particularly in settings lacking an endoscopy. Although, this should not be considered a norm. However, this suggests that the treatment of ingested foreign bodies must be individualized. Thus, multiple factors related to the child and the foreign body must be assessed before committing to invasive procedures like laparotomy. Similarly, plain X-rays can be helpful even for radiolucent foreign bodies, for diagnosis and ruling out complications. All of these are vital in underdeveloped countries, where endoscopy and computed tomography facilities might be either lacking or unaffordable by patients.

Acute intestinal obstruction secondary to ingested foreign body in an adult with autism spectrum disorder: A rare case report and review of literature

Key Clinical Message

Foreign body ingestion is common in pediatric age group however can be found in any age group with intellectual disability and neurodevelopmental delay. There is usually a delay in presentation and interventions following foreign body ingestion in patients with neurodevelopmental delay, leading to increased morbidity, mortality, and complications owing to inability of such patients giving relevant history. Most ingested foreign bodies naturally pass through the digestive tract without untoward effects. Only a few patients may require surgical interventions. Principle of management should be to reduce anxiety among patients and their visitors. Speedy recovery is enhanced so that they can return to their familiar environment soon.

Abstract

Foreign body ingestion is common in pediatric populations and may be found in any age group with intellectual disability and neurodevelopmental delay. As the patient cannot give a clear and relevant history, there is usually a delay in presentation and interventions following foreign body ingestion in patients with neurodevelopmental delay, leading to increased morbidity, mortality, and complications. Most foreign bodies pass through the digestive system without any complications, and very few require surgical intervention. The goal should be to reduce anxiety among patients and their visitors and to enhance speedy recovery so that they can return to their familiar environment soon. Here we report a case of Acute intestinal obstruction secondary to ingestion of the head portion of a doll which was managed with emergency laparotomy with enterotomy and removal of foreign body in a 16 years female with Autism Spectrum Disorder.

Morel-Lavallée lesion of the lumbosacral region: A rare case report and comprehensive review of the literature

The presentation of a Morel-Lavallée lesion in the lumbosacral region following a road traffic accident is an uncommon clinical entity. Knowledge of this rare site of occurrence can help in early diagnosis and proper management.

Migrated subcutaneous sharp foreign body in the anterior chest wall: An unusual presentation

Key Clinical Message

Migration of any foreign body can cause potentially life threatening complications and should be reviewed by a multidisciplinary approach for the management. Diagnosis can be challenging; a history of foreign body injury could be suspicious.

Abstract

Foreign body injury to the chest wall can be an emergency situation and require a multidisciplinary approach for the management of the condition. Migration of the foreign body, though rare, can lead to potentially life threatening complications and require a multidisciplinary approach for the localization of the foreign body and subsequent management of the condition. A 50-year-old male presented to the emergency department with the complaint of left sided chest pain. Upon examination, the patient was found to have a penetrating injury 6 years back by a sharp object. Radiological investigations helped in the localization of the migrating foreign body, which was removed with effective surgical intervention. The postoperative chest x-ray was normal, the patient was asymptomatic and thus the patient was discharged on the same day following surgery.

Cough syrup bottle at rectum in elderly male: a rare case report

Foreign body in the anal canal may be inserted for sexual gratification or sexual assault or accidental or drug trafficking. We report a case of a male who accidentally inserted a cough syrup bottle in his rectum. Presentation is usually late due to fear and embarrassment. The manual attempt of removal may be tried under adequate anesthesia. Post-procedure sigmoidoscopy or colonoscopy may be helpful to diagnose laceration or mucosal injury.

Sagittal Root Position of Maxillary Anterior Teeth in Nepalese Population Using Cone Beam Computed Tomography

Background There are no radiographic studies in Nepalese population for determination of sagittal root positioning in maxillary anterior teeth. The sagittal root positioning and root angulation plays a vital role for case selection in immediate implant placement. Objective To evaluate, classify and compare sagittal root position between different maxillary anterior teeth. Method A 2-year retrospective study was conducted on 100 patients (53 males and 47 females) who fulfilled the inclusion criteria using cone beam computed tomographic images. The relationship of root of tooth to its alveolar housing were recorded as Class I to IV. In addition, the root angulation relative to the alveolar process was also measured. Result The sagittal root position (SRP) calculated on six maxillary anterior teeth on average was found to be 87.83% for Class I, 6.67% for Class II, 0.67% for Class III and 5.17% for Class IV respectively. The mean root angulation was found to be higher with canines on both side whereas lateral incisors had lesser mean root angulation. Root angulation of maximum teeth were between 10-20 degrees where immediate implant placement is possible. Conclusion Within the limitations of this study, the sagittal root positioning and root angulation in Nepalese population showed a favorable result for immediate implant placement. Maximum teeth were found to be close to the alveolar process with the exception of few teeth.

Crown Lengthening Surgery for Enhancing Restorative Treatment in Esthetic Zone

For obtaining adequate retention for restoring cases like subgingival caries or extensive caries that shortens the tooth, short clinical crown, and fractures, it is usually necessary to disclose more tooth structure. Crown lengthening procedure is done to increase the clinical crown length for restorative or esthetic reasons without breaching the biologic width. These procedures are also utilized to improve the appearance and retention of restorations placed within the esthetic zone. We report a case of crown lengthening surgery with an internal bevel gingivectomy which was done in our department without compromising tooth support and esthetics.

Necrotizing Stomatitis in Varicella Zoster Infection

Necrotizing periodontal disease are acute periodontal conditions which can present with simple gingivitis to more complex life threatening condition where it can perforate the skin of cheek. They are found in patients with severe illness, stress and reduced immunity. The prevalence of this whole group of disease is usually very low and is stated frequently as the first manifestation in HIV infection. Herpes zoster, a common dermatological condition is a secondary infection due to re-activation of Varicella zoster virus in a person previously acquiring a chicken pox in his/her lifetime. There are limited scientific literatures citing the occurrence of necrotizing stomatitis in varicella zoster infection. Thus, here we present a detail about a case and management of 46 years old female who had a hospital stay of over 5 days for treatment of Herpes zoster infection of mandibular nerve presented with necrotizing stomatitis lesion within oral cavity.

The Study of Burden of Family Caregivers of Patients Living with Psychiatric Disorders in Remote Area of Nepal

Background Family caregivers of psychiatric disorders likely to face burden. There is a paucity of data regarding the caregiver burden in psychiatric disorders in context of Nepal. Objective To study the caregiver burden in families with psychiatric illness and to find association between socio-demographic variables and caregiver burden in families with psychiatric illness. Method This is an analytical cross-sectional study. The participants (n=96) were caregiver of patients visiting outpatient department of two government of Nepal primary health care centers namely, Panchkhal Primary Health Care Center (PHC) Kavre District and Barhabise Health Care Center Sindhupalchowk district. The sample size has been determined by using statistical formula. Family burden assessment schedule (FBIS) was used for the study. Result The majority of the caregivers were females 56.3%. Most of the caregivers were aged below 45 years 54.2%. The large number of participants were single or separated 74%. The mean score of family burden assessment schedule was 27 ± 9.8 (range 0 to 48) with positive rate of 59.4%.Among the objective burden domains disruption of family leisure 61.5% was the most frequently reported burden. The subjective burden was reported in 95%. There were significant differential demographic associations with different domains of caregivers' burden. Conclusion Caregivers of Psychiatric patients experience different kind of burden of care. Our findings highlight the support to the family members to reduce their burden.

Study of Infertile Couples Attending a Teaching Hospital in Eastern Nepal

INTRODUCTION

Infertility is a global health issue and a socially destabilizing condition for couples with several stigmas including medical, social, psychological burdens and a marital disharmony. The aim was to study the incidence of infertility in couples attending outdoor of Nobel Medical College and to know the contributing factors among the infertile couples.

METHODS

A prospective cross-sectional study was carried out in the outpatient department of a teaching hospital July 2015-June 2016, where the incidence of infertility and the contributing factors for the same were evaluated.

RESULTS

The incidence of infertility in this study was 5.45% and it was dominated by secondary infertility. The most important cause was male factor in 37.39%. Majority of male factor abnormality was due to exposure to heat as these male work abroad in Arabian Countries.

CONCLUSIONS

The study shows a dominance of secondary infertility and male factor being a major contributor. The most common semen abnormality was oligospermia.

Myomectomy Revisited: Experiences in a Teaching Hospital

INTRODUCTION

Uterine myomas are the most common benign tumors of the female reproductive tract with myomectomy being one of the major modalities of the treatment in our set up. The aim of this study was to share the experiences of open myomectomy from a Teaching Hospital.

METHODS

A observational study was conducted from a records of myomectomy cases in the department of Obstetrics and Gynaecology at Nobel Medical College teaching Hospital from June 2014- May 2016.

RESULTS

Total 38 cases of myomectomy were performed during the study period in the women most commong age group being 35-39 years, followed by 30-34. The most common presenting symptoms was abnormal uterine bleeding in 15 (39.47%) followed by mass per abdomen in 10 (26.31%). The most common location of the myoma was intramural followed by subserosal, submucus. Degeneration was also noted in majority of the cases. All the myomectomies were done with Inj Vasopressin injected paracervically except in one case where tourniquet was used. None of the patients had significant post-operative morbidity except fever in the first 24 hours.

CONCLUSIONS

Abdominal myomectomy is a safe and effective procedure for uterine myomas for infertile women in the past but it should be offered to those desiring for uterine preservation irrespective of age and reproductive status.

Neuroleptic malignant syndrome: case report

Neuroleptic Malignant Syndrome (NMS), a potentially fatal complication of neuroleptic therapy is described. It is found to be associated with a variety of medical and psychiatric conditions. Various risk factors and non specific investigations pathognomic to various medical conditions has been proposed. The mortality and morbidity associated with NMS can be decreased with early recognition, early discontinuation of the neuroleptics and aggressive treatment.

Evaluation of dialysis adequacy in patients under hemodialysis and effectiveness of dialysers reuses

Reuse of dialysers is being practiced since the start of hemodialysis (HD) service in Nepal, which is cost effective as well as safe. A retrospective study was done in Nepal Medical College and Teaching Hospital. We reviewed case records of the year 2008 and retrieved required data such as pre and post urea, post dialysis weight and ultrafiltration volume from 186 sessions of dialysis of 60 patients. Dialysis sessions were divided into nine groups according to the number of use of dialyser. Out of 60 patients, 40 were male. Mean age of the study population was 45.82 +/- 15.42 yrs (range 18-78). Dialysers were reprocessed manually up to 9 times. Adequacy of dialysis was assessed using single pool Kt/v (spKt/v) and urea reduction rate (URR). Mean pre urea, post urea and spKt/v were 160 +/- 51.2 mg/dL, 71.8 +/- 28.5 mg/dL and 0.95 +/- 0.28 respectively. Mean URR was 54.82 +/- 11.24%. Out of total 186 sessions, spKt/v was > or = 1.2 in only 31 sessions (17.0%). There was no significant difference in mean spKt/v between the groups (p=0.87). When compared between the individual groups e.g. 1st vs. 7th, 1st vs. 8th and 1st vs. 9th, there was no significant difference in spKt/v. Dialysis is inadequate in most of our patients undergoing HD twice a week. Reuse of dialyser is effective in urea clearance and the practice of reuse is cost effective and safe.

Vascular access for hemodialysis in Nepal Medical College and Teaching Hospital

Good vascular access is an essential component for hemodialysis (HD). Studies in patterns of vascular accesses used for HD are very few. Eighty two (male 55, female 27) patients attending HD unit of Nepal Medical College and Teaching Hospital (NMCTH) over a period of one year were enrolled for the study. Average age was 46.12 years. Seventy four patients (90.0%) were suffering from chronic kidney disease (CKD) 5 and 8 (10.0%) patients had acute renal failure. Initial vascular access used was temporary vascular access in 76 (93.0%) and arteriovenous (AV) fistula in 6 (7.0%) patients. As a first temporary vascular access femoral catheterization was used in 54 (66.0%) patients followed by subclavian and internal jugular vein catheterization in 18 (22.0%) and 4 (5.0%) respectively. Fever was observed in 9 (11.0%) patients with first temporary access. There was no complication in 65 (79.0%) cases. Other complications were poor flow, malposition, infection, thrombosis, aneurysm and self removal of catheter. Only 47 patients were analyzed for the second vascular access. Trends towards use of second vascular access was subclavian and internal jugular vein cannulation in 20 (42.5%) and 10 (21.3%) respectively, AV fistula in 13 (27.7%), and femoral catheterization in 4 (8.5%). Second vascular access was associated with fever in 7 (14.9%) and limb swelling in 1 (2.1%). Temporary vascular access was the most common access to initiate HD in CKD 5. Only 7.0% of the patient had AV fistula to start HD. Femoral vein catheterization was the most commonly used first temporary vascular access. Complications with the vascular accesses were negligible.

In-center hemodialysis for end stage kidney disease at Nepal Medical College and Teaching Hospital

End stage kidney disease (ESKD) is defined by glomerular filtration rate (GFR) less than 5 ml/min. These patients need renal replacement therapy (RRT). Hemodialysis is an established form of RRT. Studies on incenter hemodialysis are very few. Here we would like to present our experience on in-center hemodialysis in Nepal Medical College and Teaching Hospital. Study period was one year (1st Baisakh 2065 to 31st Chaitra 2065). Total 33 patients (23 male, 10 female) were enrolled in the study. Average age was 42.33 +/- 15 years. Hypertension (55.0%), diabetes mellitus (24.0%), chronic glomerulonephritis (15.0%), rapidly progressive glomerulonephritis (3.0%) and others (3.0%) were the causes of ESKD requiring dialysis. Hypotension, hypertension, muscle cramps, chest pain were the common complications observed during dialysis. Average haemoglobin level was 9.44 +/- 1.88 g%. Majority of patients were physically inactive. Blood transfusion was the main modality for correction of anaemia. Approximate cost for one session of hemodialysis was Rs. 2000 (U.S. $.25) and average monthly income of study population was Rs.16312.5 (U.S. $.204) U.S. $1 = NRs.80, (4th May 2009).