JNMA; journal of the Nepal Medical Association
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JNMA J Nepal Med Assoc · Oct 2022
Radial Head Arthroplasty among Patients with Radial Head Fracture in a Tertiary Care Centre: A Descriptive Cross-sectional Study.
Proximal radial fractures are a common type of fracture around the elbow joint. Among these comminuted radial head fractures are commonly associated with secondary injuries and instability of the elbow joint. Management of the radial head in such cases is very important in restoring the stability of the elbow joint and starting early mobilization. The aim of this study was to find out the prevalence of radial head arthroplasty among patients with radial head fracture in a tertiary care centre. ⋯ arthroplasty; elbow prosthesis; radius fractures.
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JNMA J Nepal Med Assoc · Oct 2022
Case ReportsAzathioprine Induced Pancytopenia in a Patient with Vogt-Koyanagi-Harada Disease: A Case Report.
Vogt-Koyanagi-Harada disease is a multisystem autoimmune inflammatory disorder that affects the eyes, ears, skin, and the nervous system. It is a rare disease that mainly affects Asian, Hispanic, and Middle Eastern populations. Systemic steroids and immunosuppressants are frequently used to treat autoimmune diseases like this. Despite the fact that they reduce morbidity, immunosuppressants can have a number of side effects and are difficult to use, particularly when treating uncommon autoimmune illnesses. We present a case of a 56-year-old man who visited our health facility complaining of increased tears in both eyes along with bilateral blurring of vision. He was subsequently identified as having Vogt-Koyanagi-Harada disease. After prednisolone and methotrexate failed to have the desired effect, he was treated with azathioprine, which caused pancytopenia, and manifested as fever with positive blood culture for a coagulase-negative staphylococcus infection. ⋯ case reports; pancytopenia; steroid.
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JNMA J Nepal Med Assoc · Oct 2022
ReviewPrehabilitation in Patients before Major Surgery: A Review Article.
The overall outcome of the patient after any surgery is determined not only by the fineness of the surgical procedure but also by preoperative conditioning and postoperative care. Prehabilitation decreases the surgical stress response and increases the preparedness of the patient to undergo planned surgical insult. Preoperatively structured inspiratory muscle exercises, cardiopulmonary fitness program, and planned exercise program for muscles of limbs, back, abdomen, head, and neck allow an overall upliftment of the physiological capacity of the patient to better cope with the surgical stress. Optimization of dietary status by macronutrients, micronutrients, and the nutrients has an impact on augmenting postoperative recovery and shortening the overall hospital stay. Preparing patients for the scheduled surgery and initiating alcohol and smoking cessation programs overhaul the patient's mental health and boost the healing process. This concept of prehabilitation a few weeks before surgery is equally beneficial compared to enhancing operative procedures and postsurgical care. ⋯ length of stay; mental health; nutrients; preoperative exercise; smoking cessation.
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JNMA J Nepal Med Assoc · Oct 2022
Case ReportsProtein S Deficiency with Recurrent Deep Vein Thrombosis and Post Thrombotic Syndrome: A Case Report.
Protein S is a vitamin K-dependent protein that acts as a break in secondary hemostasis by inactivating activated factor V and activated factor VIII. We report a case of a 40 years old male who had the first episode of deep vein thrombosis of the left lower limb 10 years back, which despite treatment, reoccurred 3 months later in the bilateral lower limb. Thrombophilic screening showed severe protein S deficiency. The patient then developed deep vein thrombosis of both upper limbs. The patient was advised to place an inferior vena cava filter, which he denied. The patient is now presenting with multiple episodes of post-thrombotic syndrome. Such attacks are treated with elastic compression stockings, rivaroxaban, and morphine. However, despite medication, the pain has not yet subsided. Hence, even though protein S deficiency is the rare cause of deep vein thrombosis when recurrent should be considered despite its rare occurrence. ⋯ deep vein thrombosis; protein S deficiency; rivaroxaban.
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JNMA J Nepal Med Assoc · Oct 2022
High Social Support System among Elderly in a Hilly District: A Descriptive Cross-sectional Study.
Social support is an important contributing factor that promotes the health of the elderly by providing them with positive experiences, socially satisfying roles, or the ability to cope with stressful situations. The objective of this research study is to ind out the prevalence of a high social support system among the elderly in a Hilly district. ⋯ elderly; social support; social support system.