JNMA; journal of the Nepal Medical Association
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JNMA J Nepal Med Assoc · Nov 2023
Case ReportsLaparoscopic Cholecystectomy in Situs Inversus Totalis with Stage 5 Chronic Kidney Disease: A Case Report.
Situs inversus totalis is a rare congenital anomaly in which the abdominal and thoracic organs are transposed in a mirror image. Diagnosis and management of cholelithiasis in patients with situs inversus totalis pose a challenge due to the anatomical variation. A laparoscopic cholecystectomy in such a case can be technically challenging, especially for a right-handed surgeon. In this case report, we present a case of a 38-year-old male with symptomatic cholelithiasis in a chronic kidney disease stage five patient under maintenance hemodialysis planned for recipient renal transplant. A laparoscopic cholecystectomy considered the gold standard for symptomatic cholelithiasis was performed with a three-port technique. The technical challenges anticipated due to anatomical variation were managed by intraoperative modifications. In conclusion, laparoscopic cholecystectomy in patients with situs inversus totalis can be done with technical modifications and re-orientation of visual motor skills. ⋯ case reports; cholecystectomy; situs inversus.
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JNMA J Nepal Med Assoc · Nov 2023
Diabetes Mellitus among Patients with Non-alcoholic Fatty Liver Disease Visiting the Outpatient Department of Internal Medicine in a Tertiary Care Centre.
Diabetes mellitus is a chronic metabolic illness which is mainly associated with reduced physical activity and obesity. Diabetes mellitus and non-alcoholic fatty liver disease may coexist and synergistically lead to poor clinical outcomes. The aim of the study was to find out the prevalence of diabetes mellitus among patients with non-alcoholic fatty liver disease in a tertiary care centre. ⋯ diabetes mellitus; fatty liver; non-alcoholic fatty liver disease; prevalence.
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JNMA J Nepal Med Assoc · Nov 2023
Tracheostomy among Children Admitted in the Pediatric Intensive Care Unit of a Tertiary Care Centre.
Tracheostomy is commonly performed for upper airway obstruction, prolonged mechanical ventilation and tracheo-bronchial toileting. Pediatric tracheostomy differs from adult tracheostomy in terms of surgical procedure, post-operative care and recovery. The tracheostomized patients may either be decannulated, discharged with tube-in-situ or the patient may expire. The aim of this study was to find out the prevalence of tracheostomy in patients admitted to the Pediatric intensive care unit of a tertiary care centre. ⋯ mechanical ventilation; complication; pediatric; tracheostomy.
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JNMA J Nepal Med Assoc · Nov 2023
Case ReportsChronic Lithium Toxicity in Old Age Patients Taking Angiotensin Receptor Blocker: A Case Report.
Chronic lithium toxicity is a potentially serious side effect on patients taking lithium for a prolonged period with the diagnosis of mood disorders. The toxicity is even higher in patients taking drugs that interfere with the metabolism of lithium like angiotensin receptor blockers and in older patients with reduced kidney function. In this report, we present the case of a 62-year-old woman who presented to the emergency department with symptoms including loose stools, generalised body weakness, slurred speech, coarse hand tremors, and dystonia persisting for fifteen days. She had been under lithium therapy for bipolar type 1 disorder for 15 years before experiencing these symptoms, which emerged shortly after the addition of telmisartan (angiotensinogen receptor blocker) for hypertension. ⋯ angiotensin receptor blocker; bipolar disorder; case reports; lithium; telmisartan.
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Practising medicine is all about art, skills and knowledge. According to the Tribhuvan University curriculum, the second phase, third year Bachelor of medicine and bachelor of surgery is the beginning of clinical skill learning. After studying integrated basic medical sciences for two years which is more like a conventional method of learning, the third year brings a new experience. It integrates theoretical knowledge in hospital settings by observing the patients, historytaking, examination, learning effective communication skills and empathy. ⋯ clinical skills; communication; empathy.