JNMA; journal of the Nepal Medical Association
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JNMA J Nepal Med Assoc · Aug 2022
Case ReportsEarly CT Ameliorates the Diagnostic Dilemma of "Little Old Lady's Hernia": A Case Report.
Encountering an obturator hernia itself is a rare entity for practicing surgeons globally. Synonymously known as the "old lady's hernia" is usually seen in fragile geriatric multiparous female patients. We share our experience of this rare entity where the patient presented with features of small bowel obstruction. Her diagnosis was delayed in the previously attended other centre as the possibility of an obturator hernia was overlooked. A timely clinical examination of the patient complemented by a computed tomography scan of the abdomen and pelvis helped us to obtain a diagnosis and proceed with immediate surgery. Intraoperatively the rarity was present bilaterally although the obstruction was on one side only. Prompt diagnosis and treatment benefits patients in this potentially lethal condition. ⋯ case report; computed tomography; obturator hernia; X-ray.
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JNMA J Nepal Med Assoc · Aug 2022
Severe Stress among Medical Students of Two Medical Colleges: A Descriptive Cross-sectional Study.
Mental health problems are common in medical students and there is a high prevalence of psychological morbidity among them. The inability to use effective coping strategies affects the health and academic performance of students. The aim of this study was to find out the prevalence of severe stress among medical students of two medical colleges. ⋯ coping strategies; medical students; psychological stress.
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JNMA J Nepal Med Assoc · Aug 2022
Case ReportsStatus Dystonicus with Atypical Presentation in Developmentally Delay Child: A Case Report.
Status dystonicus is characterised by involuntary sustained or intermittent muscle contractions of muscles causing repetitive twisting movements, abnormal postures of the body, or both is a rare but life-threatening movement disorder. Early diagnosis and management of status dystonicus prevent serious complications. We report a 2 years old previously developmental delay diagnosed girl who presented with generalised contractions of the whole body. Tightening of limbs is aggravated by touching her backside which is a very unique feature. Dystonia is associated with severe sweating and was confused with a seizure event. The patient was treated with midazolam, clonidine, phenytoin, gabapentin, pyridoxine, baclofen, and trihexyphenidyl. She was admitted to the intensive care unit for monitoring. The patient partially recovered after 10 days of treatment. ⋯ aspiration; children; dystonia; epilepsy; pneumonia.
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JNMA J Nepal Med Assoc · Aug 2022
Increased Great Saphenous Vein Diameter at the Level of Knee among Patients with Varicose Veins in a Tertiary Care Centre: A Descriptive Cross-sectional Study.
Colour Doppler ultrasonography plays an important role in determining the morphological and hemodynamic information of the venous system. This study aimed to find out the prevalence of increased great saphenous vein diameter at the level of the knee among patients with varicose veins in a tertiary care centre. ⋯ saphenous vein; ultrasonography; varicose veins.
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JNMA J Nepal Med Assoc · Aug 2022
Role of Tocilizumab in the Treatment of COVID-19 Patients with Cytokine Storm: A Case Series.
The in-hospital mortality in patients with COVID-19 could be correlated with severe acute respiratory syndrome coronavirus-2 induced hyper-inflammation, which is attributed to an unconstrained inflammatory cytokine storm. The pro-inflammatory cytokine, specifically, interleukin-6 plays a prominent role in the cytokine storm and may result in alveolar-capillary blood-gas exchange dysfunction. Therefore, the method to block the signal transduction pathway of interleukin-6 could be a potential treatment for severe COVID-19 patients. In this case series of three patients with severe COVID-19, we focus on the rationale for utilization of tocilizumab, an anti-interleukin-6 receptor antibody, which could block the signal transduction pathway of interleukin-6. The observations from this study allowed us to hypothesize that the infusions of tocilizumab may not reduce the elevated level of interleukin-6, and hence may not be a significant therapeutic for reducing in-hospital mortality associated with COVID-19. Additionally, it could also be speculated that interleukin-6 may not be a potentially actionable target cytokine to treat COVID-19-associated cytokine storms. ⋯ COVID-19; cytokines; interleukin-6.