JNMA; journal of the Nepal Medical Association
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Paragonimiasis contributes to significant foodborne zoonosis worldwide. The major mode of transmission in humans is by consumption of uncooked or undercooked crabs and crayfish harbouring Paragonimus metacercariae. It begins with symptoms like fever and lower respiratory involvement from a few months to a year, mimicking those of tuberculosis and leading to diagnostic delay. Here, we report two cases of paragonimiasis during a period of nine months. Both cases presented with symptoms of productive cough with rusty sputum, chest pain, along with eosinophilia, and pleural effusion and had a history of consumption of smoked crab from the local river. The diagnosis was established by microscopic demonstration of Paragonimus ova in the sputum. They were treated with praziquantel and recovered. Indeed, it is challenging to diagnose paragonimiasis due to the lack of its specific symptoms but should be considered in the differential diagnosis of eosinophilia and pleural effusion in such lung diseases. ⋯ case reports; eosinophilia; paragonimiasis; pleural effusion.
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JNMA J Nepal Med Assoc · Feb 2023
Case ReportsCecal Perforation Following Intraperitoneal Abscess after Anti-tubercular Therapy: A Case Report.
Abdominal tuberculosis is defined as infection of gastrointestinal tract, peritoneum, abdominal solid organs, and/or abdominal lymphatics constituting approximately 12% of extra-pulmonary tuberculosis cases. Intestinal perforation is an acute presentation of abdominal tuberculosis. Intestinal perforation can occur before or at the beginning of anti-tubercular therapy. It is considered to be a paradoxical reaction if it occurs during or after treatment. Intestinal perforation is uncommon but serious and life-threatening as complication-mortality rate secondary to perforation are estimated to be >30%. We present a case of an 18-year-old female who developed cecal perforation following an intraperitoneal abscess after completion of anti-tubercular therapy for intestinal tuberculosis. She was a known case of intestinal tuberculosis. She had undergone pigtail catheterisation for an intraperitoneal abscess and completed 18 months of anti-tubercular therapy after which she developed cecal perforation. A paradoxical response was observed following the completion of anti-tubercular therapy. Early diagnosis and treatment reduce the complications and mortality rates of cecal perforation due to abdominal tuberculosis. ⋯ case reports; cecum; intestinal perforation; tuberculosis.
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JNMA J Nepal Med Assoc · Feb 2023
Acute Pancreatitis among Patients Visiting the Department of Surgery in a Tertiary Care Centre: A Descriptive Cross-sectional Study.
Acute pancreatitis is the inflammation of pancreatic parenchyma characterised by severe abdominal pain and nausea. It is a common gastrointestinal disease requiring hospital admission. The death rate for mild acute pancreatitis is low but severe acute pancreatitis can reach up to 40%. This study aimed to find the prevalence of acute pancreatitis among patients attending the Department of Surgery in a tertiary care centre. ⋯ acute pancreatitis; gastrointestinal disease; prevalence.
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JNMA J Nepal Med Assoc · Feb 2023
Case ReportsEncounter with Huge Yolk Sac Ovarian Tumor in a Child: A Case Report.
Yolk sac tumour frequently arises in the gonads as a type of germ cell tumour, though rare is a highly malignant ovarian tumour in children and prompt treatment should be done. We hereby report a case of malignant ovarian tumour presenting with an abdominal lump and increased urinary frequency. Different diagnostic modalities were used such as ultrasonography of the whole abdomen, contrast-enhanced computed tomography abdomen pelvis and tumour markers of beta-human chorionic gonadotropin and alpha-fetoprotein. This revealed an 18.2x14.3x10 cm mass likely a neoplastic germ cell tumour with minimal ascites. A tumour mass was found to arise from the left ovary and complete excision of the tumour along the left fallopian tube was done. Adjuvant chemotherapy started immediately. We hereby present a case of a 9-year-old girl with a huge yolk sac tumour of the left ovary which is rare in our setting and is presented here to differentiate any ovarian mass in this age group. ⋯ children; surgical procedure; yolk sac tumour.
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JNMA J Nepal Med Assoc · Feb 2023
Case ReportsA Giant Pheochromocytoma Presenting in Pheochromocytoma Crisis: A Case Report.
Giant pheochromocytomas are rare tumors, with the majority being clinically silent. Clinically manifesting pheochromocytoma can present with symptoms of catecholamine excess, but nonspecific symptoms and variable clinical patterns of hypertension make it difficult to diagnose. Missing the diagnosis can lead to cardiovascular catastrophes like a pheochromocytoma crisis and even death. We report a 45-year-old woman on antihypertensives, repeatedly visiting a hospital for recurrent headaches finally presented in a hypertensive crisis at an emergency department. Management was started along with an injection of labetalol, which led to an unpredicted abrupt blood pressure fall, and was successfully resuscitated. Imaging and plasma metanephrine studies revealed an underlying giant pheochromocytoma, which was cured after successful surgical resection. A high degree of clinical suspicion, elaborate and focused history-taking, and initial ultrasound imaging can guide us toward the early diagnosis of pheochromocytoma. Before the alpha blockade, beta-blockers should not be used in any cases of pheochromocytoma. ⋯ case reports; headache; hypertension; pheochromocytoma.