JNMA; journal of the Nepal Medical Association
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Primary systemic amyloidosis is a systemic disease characterised by the deposition of misfolded proteins extracellularly in different organs without any known cause in the background, eventually leading to multiorgan dysfunction and death. The incidence of primary amyloidosis is estimated at 5.1-12.8 cases per million, with a poor prognosis. We report a case of a 69-year male with lower back pain, shortness of breath, and anasarca diagnosed as primary systemic amyloidosis by serum-free light chain assay and kidney needle biopsy. He was started on intravenous bortezomib and dexamethasone. Though he adhered to his medications, with time he developed renal insufficiency marked by azotemia following which hemodialysis was performed. Primary systemic amyloidosis is a rare clinical condition with a very poor prognosis. Further studies are needed to understand the proper pathophysiology and treatment of the disease. ⋯ cardiomyopathies; case reports; primary amyloidosis.
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JNMA J Nepal Med Assoc · Oct 2023
Case ReportsPercutaneous Fluoroscopy-guided Retrieval of a Fractured Pelvic Drain after Caesarean Section: A Case Report.
Iatrogenic retention of surgical drains following drain entrapment and breakage is a never event and a preventable complication. The traditional approach for removing a fractured drain from the intra-peritoneal cavity involves exploratory laparotomy. However, over the last few decades, minimal access surgery has been a more popular retrieval method for retained surgical items from peritoneal and extraperitoneal cavities. We report a case of a 32-year-old woman with a fractured pelvic drain post-caesarean section. Postoperatively, the patient developed the signs of infection and features of bowel obstruction. The mechanical obstruction was ruled out by computed tomography scan. Multiple attempts were made to pull the pelvic drain out but the tube snapped, leaving about a quarter of its length. The drain remnant was retrieved using a non-invasive, inexpensive interventional radiology technique. We could not find any such report in the literature describing this innovative approach for retrieving a fractured pelvic drain. ⋯ case report; drain fragment retrieval; fractured pelvic drain; pelvic drain remnant.
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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 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
Mean Distance of Mental Foramen from Inferior Border of Mandible among Patients Visiting the Outpatient Dental Department in a Tertiary Care Centre.
Among many anatomical landmarks in the human skull, the mental foramen is a stable landmark on the mandible. The diverse morphology of the mandible indicates the specific characteristics of such anatomical structures in each individual. The aim of this study was to find out the mean distance of mental foramen from the inferior border of the mandible visiting the Outpatient Dental Department in a tertiary care centre. ⋯ gender; mandible; mental foramen.