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  • 1
    Online Resource
    Online Resource
    Ulcerative Colitis with Superior Sagittal Sinus Thrombosis: A Case Report
    Journal of Nepal Medical Association (JNMA) ; 2023
    In:  Journal of Nepal Medical Association Vol. 61, No. 263 ( 2023-07-01), p. 611-613
    Details
    In: Journal of Nepal Medical Association, Journal of Nepal Medical Association (JNMA), Vol. 61, No. 263 ( 2023-07-01), p. 611-613
    Abstract: Ulcerative colitis is a chronic inflammatory, idiopathic, condition of the mucosa of the colon. Cerebral venous thrombosis is one of the serious and rare complications of inflammatory bowel disease. We report a case of a 27-year-old female patient with complaints of loose stool 5 to 6 episodes per day mixed with blood for 10 days. The patient has severe per rectal bleed, not controlled despite adequate measures and a few days later developed altered sensorium and fits. This case highlights prompt diagnosis and early treatment managing both severe ulcerative colitis and sagittal venous thrombosis. Immediate recognition of her disease improved her condition drastically and increased her survival.
    Type of Medium: Online Resource
    ISSN: 1815-672X , 0028-2715
    URL: Article
    DOI: 10.31729/jnma.8216
    Language: Unknown
    Publisher: Journal of Nepal Medical Association (JNMA)
    Publication Date: 2023
    detail.hit.zdb_id: 2209910-4
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  • 2
    Online Resource
    Online Resource
    Colorectal Cancer in Different Age Groups in a Tertiary Hospital in Nepal
    Journal of Nepal Medical Association (JNMA) ; 2017
    In:  Journal of Nepal Medical Association Vol. 56, No. 206 ( 2017-06-28)
    Details
    In: Journal of Nepal Medical Association, Journal of Nepal Medical Association (JNMA), Vol. 56, No. 206 ( 2017-06-28)
    Abstract: Introduction: Some studies have suggested that colorectal cancer at a younger age had distinct biological characteristics: different clinical presentations, more advanced stage at time of diagnosis and poorly differentiated carcinoma. The aim of the study is to analyze clinical and histopathological differences between younger (≤40 years of age) and older ( 〉 40 years of age) colorectal cancer patients.Methods: A cross-sectional analysis was conducted amongst the colorectal cancer patients who visited Bir Hospital between July 2015 and April 2017. All colonoscopically diagnosed and histopathologically proven cases of colon cancer were included. Chi-square test and independent t – test was performed to analyze the difference between clinical presentations and histopathological findings among two groups of patients and p value of 〈 0.05 was considered as significant.Results: Thirty younger patients and thirty older patients were enrolled without any differences in gender proportion. There were no statistical differences between clinical presentation and histological grade and type in younger and older patients. The younger patients had more complaints of altered bowel habit (p 〈 0.001) while older patients mostly presented with per rectal bleeding (p 〈 0.008).Conclusions: In this study, colorectal cancer at younger ages showed similar characteristics to those of older patients except altered bowel habit was more common in younger patients while per rectal bleeding was more common in older patients. Although colorectal cancer incidence increases with age, younger patients with altered bowel habits, weight loss, anemia and anorexia should also be given due medical attention and undergo evaluation promptly.  Keywords: carcinoma; colon; per rectal bleeding; younger group. [PubMed]
    Type of Medium: Online Resource
    ISSN: 1815-672X , 0028-2715
    URL: Article
    DOI: 10.31729/jnma.3113
    Language: Unknown
    Publisher: Journal of Nepal Medical Association (JNMA)
    Publication Date: 2017
    detail.hit.zdb_id: 2209910-4
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  • 3
    Online Resource
    Online Resource
    Outcome of Pneumatic Balloon Dilatation in Achalasia Cardia
    Nepal Journals Online (JOL) ; 2021
    In:  Journal of Advances in Internal Medicine Vol. 10, No. 1 ( 2021-05-14), p. 8-13
    Details
    In: Journal of Advances in Internal Medicine, Nepal Journals Online (JOL), Vol. 10, No. 1 ( 2021-05-14), p. 8-13
    Abstract: Background: Achalasia Cardia is a rare esophageal motility disorder. Among various treatment options, Pneumatic Dilatation (PD) is the most widely used and cost effective modality till date. This is the first observational study aiming to evaluate the short term response and complications of PD for Achalasia Cardia in Nepal. Methods: This prospective observational study was conducted between 28th Jan 2020 to 27th Jan 2021. It included 39 patients with Achalasia Cardia diagnosed by clinical presentation, esophagoscopy, barium esophagogram and high resolution manometry. Two patients of Type III achalasia were excluded from study. Thirty seven patients underwent pneumatic dilatation with 30 mm Rigiflex balloon (Boston Scientific, USA) for a duration of 1 minute. Response was assessed by Eckardts score at 3 and 6 months. Result: Among 39 cases (mean age= 39.03±15.017 years, 59% men), commonest was Type II Achalasia (71.8%) followed by Type I (23.1%) and Type III (5.1%). Dysphagia was present in all patients (100%), followed by weight loss (84.6%), regurgitation (79.5%) and chest pain (35.9%). Mean basal Eckardts score and Lower Esophageal Sphincter pressure of the study population was 7.81±1.24 and 24.40±6.83 respectively. Response to pneumatic dilatation was 89.2%. Eckardts score changed significantly from7.81±1.24 to 1.03±1.82 at 6 months (p 〈 0.001). None of the patients had major complications. Younger age (23±6.377 years) had poor response to treatment, while predilatation Lower Esophageal Sphincter pressure, gender and type of achalasia did not affect the treatment outcome. Conclusion: PD is safe and effective treatment modality for Achalasia. Younger patients have poor response to treatment with Pneumatic Dilatation.  
    Type of Medium: Online Resource
    ISSN: 2091-1440 , 2091-1432
    URL: Article
    DOI: 10.3126/jaim.v10i1.37083
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2021
    detail.hit.zdb_id: 2895109-8
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  • 4
    Online Resource
    Online Resource
    Gastrointestinal and Hepatic Manifestations in Patients with Covid-19
    Nepal Journals Online (JOL) ; 2023
    In:  Journal of Advances in Internal Medicine Vol. 11, No. 2 ( 2023-02-12), p. 47-51
    Details
    In: Journal of Advances in Internal Medicine, Nepal Journals Online (JOL), Vol. 11, No. 2 ( 2023-02-12), p. 47-51
    Abstract: BACKGROUND Gastrointestinal symptoms and Liver injury have been frequently described in patients with COVID-19.In this study, we aim to study the prevalence of Gastrointestinal symptoms and Liver injury and their impact on disease severity and clinical outcomes. METHODS This is a descriptive, cross sectional observational study done in 195 patients admitted to Bir Hospital with Corona virus Disease-19(COVID-19) from May 2021 to July 2021.Patients presenting symptoms and liver function tests (LFTs) were noted at admission. Gastrointestinal symptoms were defined as the presence of one of Nausea, Vomiting, Abdominal pain or Diarrhea. Liver injury was defined as elevation of Total Bilirubin 〉 1mg/dl or Alanine transaminase (ALT) 〉 40U/L, Aspartate Transaminase(AST) 〉 40U/L or Alkaline Phosphatase(ALP) 〉 135 U/L. Patients were followed during hospitalization and outcomes assessed at discharge. RESULTS Gastrointestinal symptoms were present in 32.3% among which Nausea (27.7%) was the commonest. There was no significant association of Gastrointestinal symptoms with duration of hospital stay, ICU admission or mortality. Liver injury was present in 72.8% patients and significantly more in those with GI symptoms than without GI symptoms. Patients with liver injury had a significantly longer hospital stay (8.92 ± 3.7 days vs 6.70±3.2 days, p=0.004), higher ICU admissions (38.02% vs 7.54% p=0.000018) and mortality (23.23% vs 1.88%, p=0.001) compared to patients with normal LFTs. CONCLUSION Gastrointestinal symptoms and Liver Injury are common in patients with COVID-19. Liver injury at admission is associated with severe disease and higher mortality. More attention should be given in the care of such patients to avoid poor outcomes.
    Type of Medium: Online Resource
    ISSN: 2091-1440 , 2091-1432
    URL: Article
    DOI: 10.3126/jaim.v11i2.52396
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2023
    detail.hit.zdb_id: 2895109-8
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  • 5
    Online Resource
    Online Resource
    Outcome of Endoscopic Variceal Band Ligation
    Journal of Nepal Medical Association (JNMA) ; 2017
    In:  Journal of Nepal Medical Association Vol. 56, No. 206 ( 2017-06-28)
    Details
    In: Journal of Nepal Medical Association, Journal of Nepal Medical Association (JNMA), Vol. 56, No. 206 ( 2017-06-28)
    Abstract: Introduction: Bleeding from esophageal varices in cirrhosis is an emergent condition with high mortality. One of the preferred modality of treating esophageal varices is EVL. We aimed to find out the outcome of EVL in controlling acute esophageal variceal bleeding, prophylactic banding to prevent future bleeding and the number of sessions required for complete eradication of varices.Methods: This descriptive observational study was carried out in Gastroenterology and Hepatology unit of Bir Hospital, NAMS from June 2016 to May 2017. Consecutive cases who presented in emergency room with acute variceal bleeding due to liver cirrhosis and cases of liver cirrhosis with large varices and red color signs on endoscopic examination were enrolled. They underwent EVL and subsequent re-endoscope at one month interval till the eradication of varices was achieved. Results: Among 83 patients, 15 (18.1%) were of Child Pugh class A, 29 (34.9%) B and 39 (47%) were of C. In 20 (24.1%) cases varices could be eradicated in one session of EVL while 57 (68.7%) required two sessions and in 6 (7.2%) cases it took three sessions. Total average EVL session required for obliteration of esophageal varices was 1.84±0.53. There was only one (1.2%) of early re-bleeding post EVL.Conclusions: EVL is an effective modality of treatment in controlling acute esophageal variceal bleeding, in preventing future variceal bleeding as well as in eradicating esophageal varices, with very few complications.Keywords: acute variceal bleeding; cirrhosis; endoscopic variceal ligation; large varices; red color sign. [PubMed]
    Type of Medium: Online Resource
    ISSN: 1815-672X , 0028-2715
    URL: Article
    DOI: 10.31729/jnma.3131
    Language: Unknown
    Publisher: Journal of Nepal Medical Association (JNMA)
    Publication Date: 2017
    detail.hit.zdb_id: 2209910-4
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  • 6
    Online Resource
    Online Resource
    Electrocardiograph and Chest X-ray in Prediction of Left Ventricular Systolic Dysfunction
    Journal of Nepal Medical Association (JNMA) ; 2009
    In:  Journal of Nepal Medical Association Vol. 48, No. 176 ( 2009-10-01)
    Details
    In: Journal of Nepal Medical Association, Journal of Nepal Medical Association (JNMA), Vol. 48, No. 176 ( 2009-10-01)
    Abstract: Abstract
    Type of Medium: Online Resource
    ISSN: 1815-672X , 0028-2715
    URL: Article
    DOI: 10.31729/jnma.343
    Language: Unknown
    Publisher: Journal of Nepal Medical Association (JNMA)
    Publication Date: 2009
    detail.hit.zdb_id: 2209910-4
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  • 7
    Online Resource
    Online Resource
    Acute Kidney Injury in Patients Using Polyethylene Glycol as Bowel Cleansing Agent for Colonoscopy
    Nepal Journals Online (JOL) ; 2022
    In:  Nepalese Medical Journal Vol. 5, No. 2 ( 2022-12-30), p. 571-576
    Details
    In: Nepalese Medical Journal, Nepal Journals Online (JOL), Vol. 5, No. 2 ( 2022-12-30), p. 571-576
    Abstract: Introduction: The use of polyethylene glycol-based solutions is the gold standard for bowel preparation for colonoscopy. However, polyethylene glycol use might be associated with the risk of acute kidney injury. We aim to find out acute kidney injury and risk factors associated with the development of acute kidney injury in patients using polyethylene glycol for colonoscopy.Materials and Methods: This was an observational study conducted in the Department of Nephrology and Gastroenterology, Bir hospital. Patients who underwent colonoscopy using polyethylene glycol were included in the study and assessed for acute kidney injury; its incidence, association of risk factors with acute kidney injury, and outcome (complete recovery or no recovery) of acute kidney injury by 3 months.Results: The mean age of the patients was 45.81 ± 18.60 years with the majority of the patients being male (60%). Out of 48 study participants, 4(8%) develop acute kidney injury. Multivariate regression analysis depicted that chronic kidney disease, chronic liver disease, congestive cardiac failure, and use of non-steroidal anti-inflammatory drugs, angiotensin receptor blockers, and diuretics drugs were the predictors which significantly influenced the occurrence of acute kidney injury in patients using polyethylene glycol.Conclusions: The evidence strongly suggests that in patients without preexisting renal disease, comorbidities, or use of drugs; the risk of renal impairment is low after colonoscopy using polyethylene glycol as a bowel cleansing agent. In the presence of risk factors for renal dysfunction, polyethylene glycol should be used cautiously.
    Type of Medium: Online Resource
    ISSN: 2645-8586 , 2631-2093
    URL: Article
    DOI: 10.3126/nmj.v5i2.48954
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2022
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  • 8
    Online Resource
    Online Resource
    EUS-guided coiling of hepatic artery pseudoaneurysm in 2 stages
    Elsevier BV ; 2017
    In:  VideoGIE Vol. 2, No. 10 ( 2017-10), p. 262-263
    Details
    In: VideoGIE, Elsevier BV, Vol. 2, No. 10 ( 2017-10), p. 262-263
    Type of Medium: Online Resource
    ISSN: 2468-4481
    URL: Article
    DOI: 10.1016/j.vgie.2017.06.005
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2017
    detail.hit.zdb_id: 2930897-5
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  • 9
    Online Resource
    Online Resource
    A Case of Juvenile Polyposis Syndrome in a 13-year-old: A Case Report
    Journal of Nepal Medical Association (JNMA) ; 2023
    In:  Journal of Nepal Medical Association Vol. 61, No. 259 ( 2023-03-01), p. 274-276
    Details
    In: Journal of Nepal Medical Association, Journal of Nepal Medical Association (JNMA), Vol. 61, No. 259 ( 2023-03-01), p. 274-276
    Abstract: Juvenile polyposis syndrome is an autosomal dominant syndrome characterised by hamartomatous polyps in the gastrointestinal tract and has a high risk for colon carcinoma. This case explores the presentation of multiple polyps throughout the gastrointestinal tract, located in the stomach, proximal duodenum, colon, rectum and up to the anal canal. The locations and number of these polyps themselves were not typical and the histopathological studies suggested the condition to be an inflammatory fibroid polyp, which is a rare, benign and solitary neoplasm. Prompt and accurate diagnostic modality remains the keystone in the identification and management of such condition which was a limitation in this case as the patient was lost to follow up before a definitive diagnosis was made.
    Type of Medium: Online Resource
    ISSN: 1815-672X , 0028-2715
    URL: Article
    DOI: 10.31729/jnma.8073
    Language: Unknown
    Publisher: Journal of Nepal Medical Association (JNMA)
    Publication Date: 2023
    detail.hit.zdb_id: 2209910-4
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  • 10
    Online Resource
    Online Resource
    Metallo-β-lactamase-producing Pseudomonas aeruginosa Isolates from Two Tertiary Care Centres in a District of Nepal: A Descriptive Cross-sectional Study
    Journal of Nepal Medical Association (JNMA) ; 2024
    In:  Journal of Nepal Medical Association Vol. 62, No. 271 ( 2024-02-29), p. 202-206
    Details
    In: Journal of Nepal Medical Association, Journal of Nepal Medical Association (JNMA), Vol. 62, No. 271 ( 2024-02-29), p. 202-206
    Abstract: Introduction: Pseudomonas aeruginosa isolates producing metallo-β-lactamase have caused nosocomial outbreaks, severe infections, and ineffective carbapenem therapy worldwide since 1991. Due to their prevalence, hospital infection control techniques are difficult. This study aimed to find out the prevalence of metallo-β-lactamase among P. aeruginosa isolates from two tertiary care hospitals in Kathmandu. Methods: A descriptive cross-sectional study was conducted at the Department of Microbiology and Department of Pathology of two tertiary care centres in Kathmandu from 7 December 2021 to 6 April 2023, after receiving ethical approval from the Ethical Review Board. Isolated strains were identified and tested for antibiotic susceptibility by modified Kirby-Bauer Methods. Metallo-β-lactamase presence was confirmed using an imipenem-imipenem/ ethylenediaminetetraacetic acid disc. A convenience sampling method was used. The point estimate was calculated at 95% Confidence Interval. Results: Among 255, Pseudomanas aeruginosa isolates, the distribution of metallo-β-lactamase-producing Pseudomanas aeruginosa was 103 (40.39%) (34.32-46.69 at 95% Confidence Interval). Multidrug resistance categories included multidrug resistance 74 (71.80%), extensively drug resistance 32 (31.10%), P. aeruginosa difficult-to-treat 16 (15.53%) and carbapenem-resistant P. aeruginosa was determined to be 82 (79.60%). Conclusions: The study found a high prevalence of metallo-β-lactamase-producing Pseudomanas aeruginosa isolates, requiring early identification, infection control measures, and an all-inclusive antimicrobial therapy protocol to reduce their spread in medical settings.
    Type of Medium: Online Resource
    ISSN: 1815-672X , 0028-2715
    URL: Article
    DOI: 10.31729/jnma.8498
    Language: Unknown
    Publisher: Journal of Nepal Medical Association (JNMA)
    Publication Date: 2024
    detail.hit.zdb_id: 2209910-4
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