Nepal Mediciti Medical Journal最新文献

{"title":"Surgical Treatment of Cerebral cavernous Malformations: Report of 6 Cases and pertinent Literature review","authors":"G. Sharma, Prasanna Karki, Sumit Joshi, D. B. Shah, P. Paudel, B. Gyawali, Baburam Pokharel, R. Panth","doi":"10.3126/nmmj.v4i1.57139","DOIUrl":"https://doi.org/10.3126/nmmj.v4i1.57139","url":null,"abstract":"Cerebral cavernous Malformation (CCM) is a rare neurovascular malformation accounting 0.5% to 4% of all intracranial vascular malformations. People harboring CCM may be symptomatic or may present with seizure, hemorrhage or progressive neurological deficit. Asymptomatic CCM needs no treatment. The symptomatic CCM may or may not require intervention. The best treatment for symptomatic CCM is microsurgical excision. Over a period of five years we have been managing I2 patients with CCM, and out of them 6 patients who were symptomatic required microsurgical excision. Here, we discuss these 6 surgically managed patients and appropriate literature related to CCMs would be reviewed.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121579626","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":"Annulling an Annulled Annular Pancreas: A Case Report","authors":"S. Ghimire, Sunil Dhakal, P. Rai, Nirvan Rai, R. Mishra","doi":"10.3126/nmmj.v4i1.57138","DOIUrl":"https://doi.org/10.3126/nmmj.v4i1.57138","url":null,"abstract":"Annular Pancreas (AP) is a rare congenital developmental anomaly which results from failure of the ventral bud to rotate to fuse with the dorsal bud, resulting in a ring of pancreatic parenchyma that surrounds the second portion of the duodenum. This rare entity can be partial or complete and the partial is even rarer. Most cases manifest in the infancy but may remain asymptomatic and various nonspecific clinical manifestations are seen in adults. We report a rare case of partial annular pancreas with atrophy of body and tail of pancreas which presented with upper gastrointestinal bleeding and obstruction. The challenge in this case was the annular pancreas was the only functioning pancreatic tissue.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"98 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115783452","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":"Silver Diamine Fluoride: A Review","authors":"Obehi O Osadolor, A. Osadolor","doi":"10.3126/nmmj.v4i1.57150","DOIUrl":"https://doi.org/10.3126/nmmj.v4i1.57150","url":null,"abstract":"BACKGROUND The burden of untreated dental caries among African children is high. Silver diamine fluoride (SDF) is a simple, non- technique sensitive intervention to stop the progression of active untreated carious lesion in primary teeth among children. Silver diamine fluoride (SDF) 38% solution contains 44,800 ppm fluoride ions and its stains teeth after use. \u0000METHOD An electronic literature search in Web of science, Scopus, PubMed, Google Scholar, African journal online, Researchgate and Google was done in May,2023. Search terms and keywords were combined by Boolean operators. Two independent investigators (research assistants) screened titles, abstracts and full text of publications. The inclusion criteria were original research articles, case report, case series related to silver diamine fluoride ( human studies) conducted in African region and in electronic databases. \u0000RESULTS Ten articles were included as they were assessed to meet the aim of the review. The study design of the articles were four invitro studies, three randomized controlled clinical trial, one randomized clinical trial, one split-mouth, self-controlled clinical trial and one split-mouth, randomized controlled clinical study. 90 % of the studies identified was conducted in Egypt, while 10 % of the studies was conducted in Nigeria. \u0000CONCLUSION Studies on silver diamine fluoride (SDF) identified in African countries were few and restricted to few countries. Silver diamine fluoride can be used as an intervention for active and progressing untreated carious lesion in primary teeth among children though it stains teeth after use. More studies from the diverse ethnic population in Africa will contribute to the existing literature.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128262861","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":"Study of Percutaneous transvenous mitral commissurotomy outcomes in valves with different Echocardiographic features","authors":"R. Rajbhandari, R. Tamrakar, J. Shah, Arya Pradhan, Sarbagya Manandhar, Utsav Dangol, Rebika Dangol","doi":"10.3126/nmmj.v4i1.57111","DOIUrl":"https://doi.org/10.3126/nmmj.v4i1.57111","url":null,"abstract":"BACKGROUND Percutaneous transvenous mitral commissurotomy (PTMC) is now a standard treatment for suitable mitral stenosis. However all procedures are not always successful or optimal. Despite having so much experience on the procedure the prediction as which types of valves give good results after PTMC is not very much defined.\u0000METHODS Initial sixty patients of PTMC of Shahid Gangalal hospital (18 male, 42 female), age ranging from 13 to 65 years, mean age 29.9±11.5 years, were studied retrospectively. Their echocardiography data before and after balloon dilatation of mitral valve were collected. The appearance of mitral valve on echocardiogram before PTMC was scored for leaflet thickening, leaflet mobility, subvalvular thickening and calcification. They were categorized into low scoring group A if they scored 8 or low, and high scoring group B if they scored above 8 according to Wilkins score.\u0000RESULTS Results were classified as successful and optimal (if valve area > 1.5cm2) or suboptimal (if valve area ≤1.5 cm2). High scoring leaflet deformity with more than 8 was associated with suboptimal results while low score group had successful outcomes and their difference was significant statistically.\u0000CONCLUSION Patients with high severity scoring of mitral valve disease had poor outcome in comparison to those with low score.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"90 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126851488","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":"Pattern of Patients in Intensive Care Unit in a Tertiary Care Hospital in Lumbini Province Nepal","authors":"R. Mandal, N. Bhandari, U. Gupta, Sailes Paudel, K. Yadav, Nirmal Shakya","doi":"10.3126/nmmj.v4i1.57137","DOIUrl":"https://doi.org/10.3126/nmmj.v4i1.57137","url":null,"abstract":"BACKGROUND Intensive care is a crucial component of hospital care, reserved for patients with potentially recoverable conditions who can benefit from invasive treatment. However, in developing countries like Nepal, resources and availability of intensive care become hurdles in delivering healthcare. This study presents the pattern of admission and outcome of patients' management in a general intensive care unit (ICU) of this tertiary care center in Lumbini Province, Nepal. \u0000METHODS A cross sectional study conducted in the Department of Internal Medicine, Bheri Hospital between July 2021 to June 2022. A total of 792 patient’s details were obtained from the record section. Demographic data, diagnosis, duration of stay in ICU, managing units, and outcome were collected and analyzed with Statistical Package for the Social Sciences 20. \u0000RESULTS A total of 729 patients were admitted in the study period; 57.82% were male and 42.18% were female. Majority 60% of admissions were from Department of Medicine followed by Cardiology 24% and Surgery 10%. Pneumonia and Chronic Obstructive Pulmonary Disease 18.30% followed by Myocardial Infraction 14.52%, Acute abdomen 10.22% and sepsis 9.84% were the most common morbidity. Mean duration of ICU stay was 3.5. days. Discharge rate was 69.82% and the mortality rate was 17.80 %. \u0000CONCLUSION The most common patients admitted in the ICU of Bheri hospital were mostly Medical cases. Surgical and obstetric cases were lesser in number. The outcomes were comparable with other multidisciplinary ICU of similar settings.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129676646","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":"A retrospective study on bacteriological profile and antibiotics prescription practice in a tertiary level intensive care unit","authors":"K. Khanal, S. Poudel, Bikash Khadka, A. Ghimire, Ashim Regmi, Manoj Bist, S. Shrestha","doi":"10.3126/nmmj.v4i1.57136","DOIUrl":"https://doi.org/10.3126/nmmj.v4i1.57136","url":null,"abstract":"BACKGROUND Antibiotics are the most commonly prescribed medicines in intensive care units (ICU). The irrational use of antibiotics leads to the development of multidrug-resistant organisms (MDR). The aim of the study is to determine the bacteriological profile of infections in our ICU and antibiotic prescription practice, before and after the culture results.\u0000METHODOLOGY This is a retrospective study conducted in a tertiary-level, 33-bedded ICU in Nepal to evaluate the bacteriological profile and antibiotic prescription practice. The patients who were admitted between a period of 3 months (January 2023 to March 2023) were enrolled. The data variables collected were; patients' details, culture samples sent (blood, urine, endotracheal (ET) aspirate, sputum, cerebrospinal fluid (CSF), wound swab, pleural fluid, ascitic fluid, tissue culture, and peritoneal fluid), gram stain results, culture sensitivity results, empirical antibiotics used, and change in antibiotics following culture results.\u0000RESULTS A total of 378 culture samples were obtained from 230 patients. A positive culture report was obtained for 165 (43.65%) of the 378 samples sent. Urine was the most common sample sent for microbiology (28%), followed by blood (25.3%) and sputum (22.75%). The percentage occurrence of gram-negative bacteria was 84%, while that of gram-positive bacteria was 16%. Methicillin- resistant coagulase-negative staphylococcus (MRCONS) was the most common gram-positive organism isolated (46.15%), and Klebsiella pneumoniae was the most common gram-negative organism (38.84%). Cephalosporin was the commonest group of empirical antibiotics used in our ICU, followed by carbapenem. Empirical antibiotic treatment was continued in 108 patients (47%), changed following the culture results in 92 patients (40%), and discontinued in 30 patients (13%). Escalation of antibiotics was done in 78 patients (85%) and de-escalation in 14 patients (15%). \u0000CONCLUSION Antimicrobial resistance and the irrational prescription of antibiotics can lead to a global economic burden. Hence, antibiotic stewardship programs are required to reduce the irrational prescribing patterns of antibiotics.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124902919","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":"Ultrasound guided suprascapular and supraclavicular nerve block in combination with continuous perineural brachial plexus block for operative management of upper limb multiple fractures: a case report","authors":"P. Bhattarai, Hemant Adhikari","doi":"10.3126/nmmj.v4i1.57143","DOIUrl":"https://doi.org/10.3126/nmmj.v4i1.57143","url":null,"abstract":"We report a case of multiple upper limb fractures resulting from a road traffic accident, wherein the patient declined general anesthesia. Instead, we successfully administered anesthesia using ultrasound-guided supraclavicular and suprascapular nerve blocks, combined with continuous perineural brachial plexus block. The surgical procedure was successfully completed within six hours, and no complications were encountered.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128910488","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":"Ocular Manifestations of Coronavirus Disease 2019 (COVID-19): Its Remedy and Prevention","authors":"S. Bhattarai","doi":"10.3980/j.issn.1672-5123.2022.12.34","DOIUrl":"https://doi.org/10.3980/j.issn.1672-5123.2022.12.34","url":null,"abstract":"SARS-CoV-2 is a Coronavirus that causes COVID-19 with mild to severe respiratory illness. It is highly contagious disease transmitted through direct or indirect contact with infected people or contaminated surfaces mainly through respiratory droplets. Several research articles are published which evaluated the ocular findings in patients with Coronavirus disease 2019. Commonly patients are suffering from initial ocular symptoms followed by systemic symptoms of the disease. Transmission even from the ocular surface could be possible via tears and other secretions through eyes. The most frequently noted initial symptom of COVID-19 is follicular conjunctivitis with acute and diffuse bilateral red eye. Similarly other ocular manifestations include eye Corneal sub epithelial infiltrates with epithelial defects,episclerits,acute anterior Uveitis, Retinitis, Optic neuritis, Cataract, Vitreous hemorrhages and cranial nerve palsies. As a remedy for ocular manifestation, orally administered Ribavirin has been used in vision threatening cases. For mild to moderate ocular symptoms ,antihistaminic eye drops with ocular lubricating drops and cool compress are till now applied. To be in safe side and to prevent the transmission from the ocular surfaces, all eye care practitioners are advised to wear personal protective equipment including gowns, gloves, masks and face shields during the ophthalmic procedures.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114032508","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":"Intramedullary Spinal Cord Tumors (IMSCTs): Outcome after surgical resection in 35 cases and review of literature","authors":"G. Sharma, Sumit Joshi, P. Poudel, Prassana Karki, D. B. Shah, Baburam Pokharel","doi":"10.3126/nmmj.v3i2.52345","DOIUrl":"https://doi.org/10.3126/nmmj.v3i2.52345","url":null,"abstract":"BACKGROUND Intramedullary Spinal Cord Tumors (IMSCTs) are rare and they represent only 5% of all spinal tumors. Ependymoma and astrocytoma are two most common IMSCTs. Due to recent advances in micro instruments, imaging and technology, aggressive surgical excision has become a safer possibility with better outcome. Aim of this study is to analyze functional outcome of patients after surgical resection of IMSCTs and review of literature. \u0000METHODOLOGY Over a period of 4 years, between May 2017 and January 2021, 35 patients were operated for IMSCTs under general anesthesia. Neurophysiological monitoring (NPM) was recently available and used only in last few cases. CUSA was used whenever required in these microsurgical procedures. This retrospective study was carried out after retrieving data from OT registers, inpatient files, OPD records, and statistical analysis was executed using SPSS software (version 18). Functional outcome was assessed by McCormick grading scale and mean follow up period was 2.5 years. \u0000RESULTS Out of 35 patients, 17 were male and 18 female. Mean age distribution was 27.57(+/-17.68). On admission, 30 patients had motor deficits, 18 had neck or back pain, 10 had sphincter dysfunction, 7 had kyphoscoliosis and 2 patients had normal neurology. MRI with IV contrast of these 35 patients revealed intramedullary lesions at cervical (11), cervicomedullary (4), thoracic (8), cervicothoracic (2), thoracolumbar (3), conus (6) and lumbar (1) regions. 22 patients had gross total and 13 had subtotal resection. Histological examination confirmed 30 glial tumors (ependymoma & astrocytoma), 2 dermoid/epidermoid, 2 neurenteric cysts and 1 secondary. Postoperative complication was 17% and there was no surgery related 30 days’ mortality. Functional outcome was measured by McCormick grade before and after microsurgical resection. Preoperatively 3(8.5%) patients had low grade or independent and 32 (91.4%) had high grade or dependent. Postoperatively and at the time of discharge 14 (40%) of patients had low grade or independent and 21 (60%) were dependent or high grade. On last followed up (4 years) 15 (48.3%) had low grade and 16 (51.6%) had high grade or dependent. In our series, on followed up of 4 years, recurrence rate was 5(14.2%), They were 2 astrocytoma, 1 secondary, and 2 myxopapillary ependymomas. Two patients with myxopapillary ependymoma were operated twice and no radiotherapy was advocated. 8 (22.6%) patients received local radiation and recurrence rate was 17.2%. \u0000CONCLUSION  Safe resection of intramedullary lesion is possible with the aid of modern neurosurgical tools, however, functional outcome relies on preoperative neurological status of the patients, extent of excision and histology of tumor. Risk factors for recurrence of IMSCTS are extent of resection and histological behavior of tumor.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115538537","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":"Low-volume Plasma Exchange In Immune-mediated Neurological Diseases : A tertiary care center study","authors":"Aashish Shrestha, B. Gajurel, R. Karn, R. Ojha, R. Rajbhandari, N. Gautam, Sumit Shahi, P. Ghimire, Pradeep Panthee, S. Bijukchhe","doi":"10.3126/nmmj.v3i2.52363","DOIUrl":"https://doi.org/10.3126/nmmj.v3i2.52363","url":null,"abstract":"BACKGROUND The optimal cost benefit of standard plasma exchange (SPE) has not been met where most of the patients do not afford the treatment. As an alternative, low volume plasma exchange (LVPE) is cost-effective than SPE where albumin replacement is eliminated. The aim of this study was to analyse the efficacy and safety of LVPE in various Immune mediated neurological diseases (IMND). \u0000METHODS A hospital-based retrospective study was conducted in patients with IMND who were admitted in TUTH between October 15, 2020, and October 14, 2022. Hemodynamically stable patients over the age of 18 who met the plasma exchange criteria were eligible. Outcomes and treatment-related complications were studied separately for the different diseases. \u0000RESULTS Of the 29 patients enrolled, 3 had Myasthenia gravis (MG), 6 had Neuromyelitis optica spectrum disorder (NMOSD), 11 had Gullian Barre syndrome (GBS), 6 had Chronic inflammatory demyelinating polyneuropathy (CIDP), and 3 had Autoimmune encephalitis (AE). Patients with MG, GBS, and CIDP all showed statistically significant improvement in mRS scores from 2.3±0.6 to 0 (p value = 0.0198), 3.03±1.8 to 2.2±1.4 (p value=0.0046) and 2.5±1.4 to 1.8±1(p value=0.025) respectively by the time they were discharged following treatment. Two patients developed Deep vein thrombosis (DVT), and two developed anaphylaxis during the course of their treatment, although none deteriorated further while in the hospital. \u0000CONCLUSION LVPE was effective in MG, GBS and CIDP. Myasthenia crisis patients who re-quired mechanical ventilation demonstrated complete resolution with LVPE making it a potential life-saving alternative for those who cannot afford standard therapy.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"368 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114786932","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}