JNMA; journal of the Nepal Medical Association
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JNMA J Nepal Med Assoc · Jan 2020
Case ReportsThyroid storm presenting as septic shock in the intensive care unit: A Case Series.
Thyroid storm is a rare endocrine emergency that rarely presents with septic shock. It occurs in thyrotoxic patients and is manifested by decompensation of multiple organs, triggered by severe stress. The diagnosis and response to treatment is made by Burch-Wartofsky point scale or Japanese thyroid association criteria due to lack of pathophysiology of thyroid storm. ⋯ Patient were treated initially for septic shock, later diagnosed as thyroid storm and was treated with oral carbimazole, propanolol and digoxin. From this, we want to emphasize that thyroid storm can have any presentation that should be kept in differential diagnosis of septic shock not responding to usual treatment; early diagnosis and treatment with oral medication can decrease morbidity and mortality in rural setting where intravenous form of antithyroid drug are not available for thyroid storm. Keywords: sepsis; septic shock; thyroid storm.
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Composite tumor of larynx, a recently included entity in the current WHO classification, is often a difficult pathological diagnosis, especially in small biopsies. We report a case of laryngeal composite tumor, initially misdiagnosed as squamous cell carcinoma, which later turned out to be composite in nature, with associated neuroendocrine (small cell carcinoma) component. This report emphasizes the need for obtaining deeper biopsies and their thorough pathological examination to improve the diagnostic accuracy. Keywords: combined small cell carcinoma; composite tumor; larynx; small cell carcinoma; squamous cell carcinoma.
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JNMA J Nepal Med Assoc · Jan 2020
Prevalence of Postpartum Family Planning Service Coverage in Selected Referral Facilities of Nepal.
Nepal Society of Obstetricians and Gynecologists jointly with the Nepalese government and with the support from the International Federation of Obstetrics and Gynecology has implemented an initiative to institutionalize postpartum family planning services in selected major referral facilities of Nepal to address the gap of low uptake of postpartum family planning in Nepal. The aim of the study is to find the prevalence of the service coverage of postpartum contraception in the selected facilities. ⋯ The coverage of Postpartum Intrauterine Device counseling service coverage in Nepal is higher in 2018 as compared to 2016-2017 and in other countries implementing Postpartum Intrauterine Device initiatives. However, the prevalence of service coverage of immediate Postpartum Family Planning methods, mainly Postpartum Intrauterine Device in 2018 is lower in Nepal as compared to 2016-2017, and other countries implementing Postpartum Intrauterine Device initiative. More efforts are needed to encourage mothers delivering in the facilities to use the postpartum family planning method.
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JNMA J Nepal Med Assoc · Jan 2020
Prevalence of Covert Hepatic Encephalopathy in A Tertiary Care Centre.
Among patients with Hepatic Encephalopathy, prevalence of Minimal HE varies between 30-50%. Identifying patients with MHE has been shown to improve with medications and delay development of Overt HE, however only limited clinicians screen for MHE in patients due to time consuming neuropsychological and neurophysiological tests. The Number Connection Test is an easy way to evaluate patients to diagnose MHE. The aim of this study is to find out the prevalence of covert hepatic encephalopathy. ⋯ Our study showed that although the prevalence of minimal HE is quite high among cirrhotics, they are usually missed in clinical practice due to absence of symptoms. Active screening with easy-to-administer tests, like Number Connection tests, can help identify patients with minimal HE and hence treat them early.
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JNMA J Nepal Med Assoc · Jan 2020
Satisfaction Level among Patients Treated with Fixed Dental Prosthesis in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.
Dental treatment aims at correction of existing disease; prevention of future disease with rehabilitation of patient's lost functional capacity and aesthetics. Fixed dental prosthesis is any prosthesis that is cemented to a natural tooth or dental implants abutments that cannot be removed by patient. The success of prosthodontic treatment is related to prosthesis survival, with its ability to fulfil biologic and patient-evaluated objectives with patient satisfaction. This study is aimed to find the patient satisfaction with fixed prosthodontic treatment. ⋯ Several factors (chewing ability, appearance, speech, cleansibility of fixed prosthesis) had positive impact on overall satisfaction in majority of the patients. Dentists should continue to emphasise on the significance of maintaining good oral hygiene and use of interdental aids for the longevity of fixed prosthesis.