JNMA; journal of the Nepal Medical Association
-
JNMA J Nepal Med Assoc · Jul 2022
Modern Paediatric Radiology: Meeting the Challenges in CT and MRI.
Radiology plays a very important part in the diagnosis, treatment, and follow-up of children. Computed tomography and magnetic resonance imaging are the two most crucial developments in the modern era. However, the two modalities have their challenges to overcome. Radiation dose is the most unwanted side effect of computed tomography scans while longer scan time along with sedation is a major disadvantage in children during magnetic resonance imaging. Paediatric-specific protocol selection and limiting the exposure to the area of interest aid in reducing the dose during computed tomography scans. Faster scan protocols and sequences can result in imaging without sedation in magnetic resonance imaging. Considering the radiation exposure, "as low as reasonably achievable" principle should be followed strictly in the paediatric population. In this article, possible ways for minimising the radiation dose in computed tomography, as well as effective, short, and sedation-free magnetic resonance imaging, are discussed. ⋯ computed X-ray tomography; magnetic resonance imaging; pediatrics; radiation exposure; X-ray.
-
JNMA J Nepal Med Assoc · Jul 2022
Case ReportsD-penicillamine Induced Myasthenia Gravis in Wilson's Disease: A Case Report.
Myasthenia gravis is a neuromuscular junction disorder characterised by fluctuating muscle weakness, improved by using anti-cholinesterase drugs. In addition to the autoimmune aetiology, various factors such as infections, surgery, and drugs are known to precipitate the condition. We report a case of a 15-year-old boy with D-penicillamine-induced myasthenia gravis who presented with facial diplegia, dysphagia, and drooling of saliva, 6 years after the initiation of treatment for Wilson's disease. Therefore, clinicians should be more vigilant while prescribing patients with chelating drugs like D-penicillamine with regular monitoring of the new symptoms and keeping a very low threshold for the suspicion of myasthenia gravis. ⋯ d-penicillamine; myasthenia gravis; pyridostigmine; Wilson's disease.
-
JNMA J Nepal Med Assoc · Jul 2022
Case ReportsLoss of Consciousness and Cardiac Arrest as an Atypical Presentation of Tubercular Meningitis: A Case Report.
Tubercular meningitis is a devastating presentation of extra pulmonary tuberculosis, with fatality in each case without treatment. A 39 years male, a regular consumer of alcohol and a known case of major depressive disorder, presented with the alleged history of using an electric heater in a closed room, and presented to emergency with unconsciousness and cardiac arrest. As his neurological status didn't improve over 72 hrs, a magnetic resonance imaging brain was done which was non-conclusive. Electroencephalogram revealed diffuse right fronto-parietal seizure activity ceasing with midazolam injection, hence levetiracetam was started. Lumbar puncture revealed increased adenosine deaminase and nil white blood cells. Repeat lumbar puncture showed lymphocytic-predominant pleocytosis, elevated protein and low glucose. The patient was started on anti-tubercular therapy and an injection of dexamethasone was added. Repeat electroencephalogram didn't show any seizure-like activity. It is important to be aware of variety of presentations of tubercular meningitis. Delay in treatment leads to irreversible neurological damage and even death. ⋯ cardiac arrest; case report; tubercular meningitis; unconsciousness.
-
JNMA J Nepal Med Assoc · Jul 2022
Hypothyroidism among Female Medical Students in a Teaching Hospital: A Descriptive Cross-sectional Study.
Hypothyroidism is a common clinical condition of thyroid hormone deficiency and is frequently seen in women. Studies regarding the prevalence of hypothyroidism among healthy young adult females are very less. This study aimed to find out the prevalence of hypothyroidism among female medical students in a teaching hospital. ⋯ hypothyroidism; medical student; prevalence; thyroid stimulating hormone; thyroxine.
-
Ameloblastomas of jaws are benign odontogenic tumors of epithelial origin with four clinical variants: solid multicystic type, unicystic type, desmoplastic type, and extraosseous type. The incidence rate of ameloblastoma is 0.92 per million person-years. Unicystic ameloblastoma refers to those cystic lesions that show clinical and radiologic characteristics of an odontogenic cyst but shows a typical ameloblastomatous epithelium lining part of the cyst cavity, with or without luminal and/or mural tumor proliferation on histological examination. Here is a unique case of unicystic ameloblastoma involving the mandible in a 70-year-old patient. The case was managed by segmental mandibulectomy and flap repair. Unicystic ameloblastoma accounts for only 13% of all known cases in scientific literature. Considering the rarity of the lesion, the purpose of presenting this report on a clinical case is to emphasize the importance of radiological evaluation and histopathological examination for the diagnosis of ameloblastoma. ⋯ ameloblastoma; odontogenic cysts; odontogenic tumors; segmental mandibulectomy.