JNMA; journal of the Nepal Medical Association最新文献

{"title":"Cartap Poisoning with Paroxysmal Supraventricular Tachycardia: A Case Report.","authors":"Newton Ashish Shah, Bibek Rajbhandari, Santosh Banstola, Manish Acharya, Rupesh Joshi, Shree Krishna Luitel, Manish Yadav","doi":"10.31729/jnma.8772","DOIUrl":"10.31729/jnma.8772","url":null,"abstract":"<p><p>Cartap, a nereistoxin derivative from the marine annelid Lumbriconeresis heteropoda, is widely used as a pesticide, targeting pests like caterpillars. While the WHO classifies it as moderately hazardous, with a recommended daily intake of 0.05 mg/kg, human toxicity reports are limited. A 34-year-old female was admitted after consuming an unknown poison. She reported epigastric pain, burning sensations, sweating, vomiting, dyspnea, palpitations, and restlessness, compounded by alcohol intake. Initially treated for organophosphate poisoning, her cholinesterase level was 8.91. It was later confirmed she ingested 100 ml of 50% concentration cartap. Treatment included amiodarone for supraventricular tachycardia and intravenous N-acetylcysteine, magnesium sulfate, and midazolam for general tonic clonic seizure. Cartap, toxic through ingestion and skin contact, can cause symptoms such as vomiting, convulsions, and cardiac issues like supraventricular tachycardia. Supportive care is crucial, and awareness of its risks is necessary.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"62 278","pages":"702-705"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11619541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Thyroid Dysfunction among Patients with Type II diabetes Mellitus in Tertiary Care Center: A Cross-sectional Descriptive Study.","authors":"Lokraj Kandel, Yagya Laxmi Shakya, Manish Yadav, Newton Ashish Shah, Sanjay Gupta","doi":"10.31729/jnma.8787","DOIUrl":"10.31729/jnma.8787","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes mellitus (DM) and thyroid dysfunction (TD) are two of the most prevalent endocrine disorders globally. Both conditions have significant effects on metabolism and are known to influence each other. Thyroid hormones play a crucial role in glucose homeostasis by affecting insulin secretion, sensitivity, and glucose metabolism. Conversely, altered glucose metabolism in diabetes can impact thyroid function, leading to a higher prevalence of thyroid disorders in diabetic patients. Understanding this relationship is important for improving the clinical management of patients with Type II DM. However, there is limited data on the prevalence of thyroid dysfunction in diabetic populations within specific regions.</p><p><strong>Methods: </strong>A cross-sectional descriptive study was conducted from February to September 2023 among 209 patients diagnosed with Type II DM at a tertiary care center after obtaining ethical approval from Institutional Review Committee(Reference No: 367 (6-11) E2). Thyroid function was assessed using thyroid-stimulating hormone (TSH), free T3 (FT3), and free T4 (FT4) levels. Thyroid dysfunction was classified into hypothyroidism and hyperthyroidism based on standard clinical and laboratory criteria. Data management involved entry into Microsoft Excel, verification for accuracy, and subsequent analysis using SPSS version 29.</p><p><strong>Results: </strong>The study included 209 patients with 128 (61.24%) females and a mean age of 65.87±13.7 years. The prevalence of thyroid disorders was 77 (36.84%) 53(25.36%) hypothyroidism,24 (11.48%) hyperthyroidism among patient with type II diabetes mellitus.</p><p><strong>Conclusions: </strong>Our study shows a high prevalence of thyroid disorders, especially subclinical hypothyroidism, in individuals with type 2 diabetes. Poorly controlled blood glucose (HbAlc > 7.5) significantly increases the risk, underscoring the need for routine thyroid screening in T2DM management.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"62 278","pages":"691-696"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11619547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical Variations in Keystone Area in Nepalese Noses: A Descriptive Cross-sectional Study.","authors":"Urmila Gurung, Kripa Dongol, Pabina Rayamajhi, Bijaya Kharel, Leison Maharjan","doi":"10.31729/jnma.8776","DOIUrl":"10.31729/jnma.8776","url":null,"abstract":"<p><strong>Introduction: </strong>The keystone area, a crucial part of the nasal dorsum that maintains its structural stability, is known to have anatomical variations. This study aimed to evaluate these anatomical variations in Nepalese noses.</p><p><strong>Methods: </strong>This was an observational, analytical study done at a tertiary center after taking ethical approval {208(6-11)E2-077/078}. Thirty-one cadaveric noses consisting of 26 males and five females aged 24 to 70 years were dissected. The shape of the caudal margin and the overlap pattern of the nasal bone over upper lateral cartilage were assessed. The proportion of overlap was calculated. The lengths of the lateral and dorsal keystone and dorsal quadrangular cartilage were measured.</p><p><strong>Results: </strong>The most common shape of the nasal bone caudal margin was curvilinear 15 (48.39%) followed by paramedian retractions 8 (25.81%). Elongated midline was the least commonly seen in 1 (3.23%) female only. The length of the dorsal keystone ranged from 1-12 mm (mean 6.97±2.57) whilst the lateral keystone measured 1-4 mm (mean 2.22±1.20). The dorsal quadrangular cartilage measured 21-39 mm (mean 29.77±4.6). The mean overlap proportion was 23.82±7.33 (11 - 40)%.</p><p><strong>Conclusions: </strong>Anatomical variations in the structural components of the keystone area in Nepalese was seen in the study.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"62 278","pages":"681-685"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11619543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Intersection of Neuroscience and Criminology: Role of Brain Mapping in Addressing Criminal Behavior by Nepal Police.","authors":"Bibek Rajbhandari, Sushant Regmi, Kanchan Dahal, Sandesh Shrestha","doi":"10.31729/jnma.8786","DOIUrl":"10.31729/jnma.8786","url":null,"abstract":"<p><p>Neuroscience is being integrated into criminal investigations, offering new opportunities for understanding, predicting, and potentially preventing criminal behavior. In Nepal, brain-mapping techniques like P300 wave tests and Brain Electrical Oscillation Signature profiling were used in a murder investigation in 2024. However, ethical concerns include privacy concerns, false positives, and the potential for false positives. Consent regarding neurobiological evidence in criminal cases is crucial, as intrusive procedures may require individuals to be informed. The legal implications of using neurobiological evidence could be severe if it serves to wrongfully accuse or convict an individual. Therefore, the use of neuroscience in criminology must be carefully balanced to ensure ethical considerations. This viewpoint interprets the potential of neuroscience in criminal investigations, addressing ethical, privacy, consent, and legal issues within the Nepal Police and criminal justice system.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"62 278","pages":"709-711"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11619553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Study of Cutaneous Manifestations in Neonates in A Tertiary Care Center in Eastern Nepal: A Descriptive Cross-sectional Study.","authors":"Anil Timilsina, Nisha Keshary Bhatta, Nidhi Shah","doi":"10.31729/jnma.8783","DOIUrl":"10.31729/jnma.8783","url":null,"abstract":"<p><strong>Introduction: </strong>In the neonatal period, a variety of cutaneous symptoms are frequent. To minimize unneeded therapy and to reduce parents' stress, it's important to distinguish between transient and pathological newborn dermatoses. The purpose of this study is to describe the clinical pattern of cutaneous lesions in neonates.</p><p><strong>Methods: </strong>In this cross-sectional descriptive study, we enrolled 512 neonates born and admitted in maternal child health care ward and Post Natal ward of a tertiary health care center irrespective of cutaneous manifestations. Convenience sampling technique was used. They were examined till their stay in hospital and followed up weekly via telephone for development of dermatological manifestations.</p><p><strong>Results: </strong>Out of 512 neonates examined, 415 (81.05%) of neonate had at least one cutaneous manifestation, 393 (94.69%) had physiological skin lesions, 22 (5.31%) had pathological skin lesions. The most common physiological skin manifestations were sebaceous gland hyperplasia, mongolian spot, ETN, milia and epstein pearl. The pathological cutaneous manifestations though least common comprised of cradle cap, napkin dermatitis and bacterial infections. Most of the lesions were present within 24 hours of birth and many of them were physiological transient lesion.</p><p><strong>Conclusions: </strong>In conclusion, our study highlights the high prevalence of cutaneous manifestations in neonates, with the majority being physiological in nature. Medical personnel must be well versed in the skin changes of neonates which will further help prevent unnecessary treatment and identify life threatening situations that require additional attention.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"62 278","pages":"655-663"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11619548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic Debridement and Proximal Fibular Osteotomy in the management of knee Osteoarthritis: A Descriptive Longtudinal Study.","authors":"Vijayendra Adhikari, Prasamsha Sitaula, Ojas Thapa, Sumi Singh, Praphulla Shrestha, Pralhad Kumar Chalise, Anil Kumar Mishra, Ramesh Prasad Singh","doi":"10.31729/jnma.8778","DOIUrl":"10.31729/jnma.8778","url":null,"abstract":"<p><strong>Introduction: </strong>Knee osteoarthritis commonly occurs in the medial compartment. Arthroscopic debridement eases pain by irrigating debris and inflammatory cytokines. Proximal fibular osteotomy shifts the loading force more laterally from the medial compartment, eliminating pain and delaying degenerative progression. This study aims to evaluate pain relief by combining both procedures in knee osteoarthritis of the medial compartment.</p><p><strong>Methods: </strong>The study was conducted in Nepal Medical College Teaching Hospital from November 2021 to December 2022 after the ethical approval from institutional review committee (IRC Ref. No. 025-078/079). The outcome was assessed by visual analog score and knee society scores, who underwent a combined procedure of arthroscopic debridement and proximal fibular osteotomy during a study period of 12 months.</p><p><strong>Results: </strong>Diagnostic arthroscopy was done in 32 patients, out of which, 27 patients underwent combined procedure with arthroscopic debridement and proximal fibular osteotomy. The mean visual analog score in combined procedure was 6.89±0.93 initially and 3.11±0.69 at 12 months follow up. The mean knee society score in combined procedure was 46.85±6.1 preoperatively and 84.26±8.27 postoperatively at 12 months follow up. Common peroneal nerve neuropraxia was observed in 8 (29.62%) patients, which resolved spontaneously during 6 months of time period.</p><p><strong>Conclusions: </strong>Combined arthroscopic debridement and proximal fibular osteotomy procedure is effective in treating knee osteoarthritis of the medial compartment, as it decreases pain and improves knee society score.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"62 278","pages":"686-690"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11619539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pattern of Mortality among Patients Admitted in Medical Wards in a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study.","authors":"Min Chandra Adhikari, Surendra Lal Shrestha, Sarbesh Sharma, Suresh Prasad Nepal","doi":"10.31729/jnma.8784","DOIUrl":"10.31729/jnma.8784","url":null,"abstract":"<p><strong>Introduction: </strong>Most developing regions of the world are undergoing gradual epidemiological transition resulting in high burden of both communicable and noncommunicable diseases. Morbidity and mortality pattern is a reflection of disease burden. Detailed assessment of these parameters tends to aid in formulating pivotal aspects of in-hospital policies, standards of care and so consequently promoting efficient work systems. The aim of this study is to identify the pattern of mortalities in medical wards in a tertiary care hospital.</p><p><strong>Methods: </strong>This retrospective descriptive cross-sectional study was conducted in National Academy of Medical Sciences, Bir hospital focusing on all patients admitted to the medical wards (General Medical, Hepatology, Nephrology, Neurology, Endocrinology, Pulmonology, Cardiology and Gastrology) between January 1, 2023 to December 31, 2023 after obtaining ethical approval from Institutional Review Committee (Reference number: 390/2080/81). Total population sampling was done. Data were analyzed using Microsoft Excel and SPSS.</p><p><strong>Results: </strong>Among 10124 admitted patients in medical wards, mortality was reported in 732 (7.22%). The number of deaths seen in general medical ward was 389 (53.14%) and in hepatology ward was 85 (11.61%). Systemic cause of death due to respiratory diseases was 157 (21.43%) and liver disease was 143 (19.54%).</p><p><strong>Conclusions: </strong>The respiratory disease is responsible for a higher proportion of deaths among admitted patients.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"62 278","pages":"664-668"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11619549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Staphylococcal Scalded Skin Syndrome Complicated by Methicillin-Resistant Staphylococcus Aureus and Steroid Abuse: A Case Report.","authors":"Ujjwal Kumar Jha, Ajay Kumar Yadav","doi":"10.31729/jnma.8770","DOIUrl":"10.31729/jnma.8770","url":null,"abstract":"<p><p>Staphylococcal Scalded Skin Syndrome (SSSS) is a severe exfoliative skin condition primarily affecting children, caused by the toxins produced by <i>Staphylococcus aureus.</i> This case report describes the clinical presentation, diagnostic challenges, and successful management of SSSS complicated by Methicillin-Resistant <i>Staphylococcus aureus</i> (MRSA) in a pediatric patient. A pediatric patient presented with a two-week history of pruritic vesiculobullous eruptions that progressively worsened. Despite initial treatments with various topical and oral medications including steroid and antibiotic ointments, the lesions continued to progress. A wound culture identified heavy growth of MRSA, prompting a change in the treatment regimen, resulting in significant clinical improvement. This case underscores the importance of accurate diagnosis and timely intervention in the management of SSSS, particularly when complicated by MRSA. The successful outcome with appropriate antibiotic therapy highlights the need for a multidisciplinary approach and emphasizes the value of culture and sensitivity testing in guiding effective treatment strategies.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"62 278","pages":"697-699"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11619542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Neonate Presenting with Severe Dehydration: A Rare Case of Congenital Adrenal Hyperplasia with Salt Losing Crisis.","authors":"Anita Lamichhane, Rekha Phuyel, Manish Upreti, Ramesh Khadka","doi":"10.31729/jnma.8777","DOIUrl":"10.31729/jnma.8777","url":null,"abstract":"<p><p>Congenital adrenal hyperplasia (CAH) is a rare autosomal recessive disorder caused by mutations in genes involved in cortisol biosynthesis in the adrenal gland. Depending on the enzymatic defect, the symptoms, signs, and laboratory findings differ. The most common form, accounting for more than 95% of cases, is caused by 21-hydroxylase deficiency. Delay in the diagnosis and treatment can lead to life-threatening adrenal crisis with hemodynamic collapse. We report a case of a five-day-old male neonate with congenital adrenal hyperplasia and salt-wasting crisis. The diagnosis was made after comprehensive assessment of clinical features and laboratory investigations. He was treated with hydrocortisone and fludrocortisone and was discharged after one week.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"62 278","pages":"706-708"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11619546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between Serum Albumin Level and Severity of Acute Ischemic Stroke: A Cross-Sectional Study.","authors":"Binod Pantha, Milan Khadka, Lochan Karki, Parimal Koirala","doi":"10.31729/jnma.8792","DOIUrl":"10.31729/jnma.8792","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke is a leading cause of disability with devastating consequences. Serum albumin has emerged as a significant prognostic marker in various conditions, including stroke. This study aims to investigate the relationship between serum albumin levels and stroke severity and outcomes in patients with acute ischemic stroke (AIS).</p><p><strong>Methods: </strong>An observational, cross-sectional study was conducted over six months at Bir Hospital, among patients admitted in medicine ward after obtaining the ethical approval reference number 34/20081/82. Total population sampling was done. Serum albumin at the time of diagnosis was measured. Ischemic stroke severity was scored based on NIHSS score on admission and the functional outcome was evaluated as modified Rankin Scale (mRS). Finally, correlation of serum albumin with the severity and the outcome of stroke (mRS) was made.</p><p><strong>Results: </strong>The study of 37 patients showed significant correlation between serum albumin and NIHSS score. The study showed moderate to strong negative correlation between serum albumin levels and mRS scores. The mean serum albumin level was 3.5±0.40 mg/dl.</p><p><strong>Conclusions: </strong>Significant correlation of serum albumin level with clinical severity at the time of admission and with the outcome during discharge was found. Thus serum albumin has prognostic significance in acute ischemic stroke.</p>","PeriodicalId":520657,"journal":{"name":"JNMA; journal of the Nepal Medical Association","volume":"62 278","pages":"669-674"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11619538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}