JNMA; journal of the Nepal Medical Association
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JNMA J Nepal Med Assoc · Oct 2023
Case ReportsSystemic Sclerosis with Inflammatory Myositis: A Case Report.
The overlap of systemic sclerosis and inflammatory myositis is a rare disorder which results in immune system activation and production of autoantibodies. We present a case of a 28-year-old female with complaints of generalized weakness, multiple joint pain, facial puffiness, and blackish discolouration of skin over the last 4 months. Blood investigations demonstrated autoantibodies positive for overlap syndrome. She was managed with hydroxychloroquine, mycophenolate mofetil and steroids. This case report highlights the importance of early diagnosis and treatment of this rare entity for better patient outcomes. ⋯ antibodies; case reports; inflammation; systemic sclerosis.
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JNMA J Nepal Med Assoc · Oct 2023
Case ReportsKlippel-Feil Syndrome Associated with Renal and Cardiac Anomalies in an Infant: A Case Report.
Klippel-Feil syndrome is a rare congenital bone disorder characterised by a triad of short neck, low posterior hairline and limited lateral bending of the neck with an annual incidence of 1 in 40,000 live births. It has remained an obscure term in the medical literature because of its variability in presentation and wide spectrum of anomalies involving multiple organ systems. It is unusual to find a case that has all three classical triad features. Here, we present a case of a 9-month-old infant who manifests not only all three classical triad features associated with Klippel-Feil syndrome but also demonstrates the presence of congenital heart disease, scoliosis, and renal ectopia. An early comprehensive evaluation of a suspected case is essential for diagnosis and counselling which impacts its prognosis, helps minimize social stigma and affords parents the opportunity to consider cosmetic surgery as an option, should they choose to pursue it. ⋯ case reports; congenital; heart diseases; Klippel-Feil syndrome; scoliosis.
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JNMA J Nepal Med Assoc · Oct 2023
Prostate Cancer among Patients Undergoing Radical Cystoprostatectomy for Bladder Cancer in the Department of Urology in a Tertiary Care Centre.
Prostate cancer is the most common malignancy in men and remains one of the most prevalent and least understood of all human malignancies. Bladder cancer is the most frequently diagnosed cancer in China. Radical cystectomy remains the gold standard for muscle-invasive, recurrent and multiple bladder cancer. All male patients undergoing radical cystoprostatectomy must be evaluated for prostate cancer before planning surgery. The aim of this study was to find out the prevalence of prostate cancer among patients undergoing radical cystoprostatectomy undergoing surgery for bladder cancer. ⋯ bladder cancer; incidental findings; prostate cancer.
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JNMA J Nepal Med Assoc · Oct 2023
Portal Hypertension among Patients with Chronic Liver Disease Admitted to the Department of Internal Medicine of a Tertiary Care Centre.
Portal hypertension is increased pressure within the portal vein. A portal pressure gradient of more than 10 mmHg is defined as "clinically significant portal hypertension" due to manifestations such as splenomegaly, gastroesophageal varices, ascites, hepatorenal syndrome, hepatopulmonary syndrome, hepatic encephalopathy, and spontaneous bacterial peritonitis. The aim of this study was to find out the prevalence of portal hypertension among patients with chronic liver disease admitted to the Department of Internal Medicine of a tertiary care centre. ⋯ inpatients; liver disease; portal hypertension; prevalence.
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JNMA J Nepal Med Assoc · Oct 2023
Case ReportsIschemic Portal Venous Gas and Pneumatosis Intestinalis Managed Conservatively in a Patient with Rheumatic Heart Disease and Warfarin Induced Coagulopathy: A Case Report.
Mesenteric ischemia is a surgical emergency. The presence of hepatic portal venous gas and pneumatosis intestinalis is a frequent finding in computed tomography. Not all hepatic portal venous gas and pneumatosis intestinalis are due to mesenteric ischemia. A 70-year-old female, with a known case of diabetes mellitus, rheumatic heart disease and atrial fibrillation under warfarin presented with diffuse abdominal pain, multiple episodes of vomiting and ecchymosis in bilateral flanks. Evaluation of the coagulation profile suggested warfarin-induced coagulopathy. Portal venous gas was detected during an ultrasound examination. Subsequent contrast-enhanced computed tomography abdomen showed hepatic portal venous gas, pneumatosis intestinalis, paucity of branches of the ileocolic artery, and reduced enhancement of caecum and ascending colon. Mild ascites were present in the pelvis. Arterial blood gas analysis revealed compensated metabolic acidosis. The patient was managed conservatively and discharged after nine days of hospital admission. Conservative approach can be considered for suspected mesenteric ischemia in surgically unfit candidates. ⋯ case reports; mesenteric ischemia; portal vein; rheumatic heart disease; warfarin.