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NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .

Monday, February 29, 2016

depressed mood for 4 months-DrSudeepKC

A 32-year-old woman is seen in an outpatient psychiatric clinic for the chief complaint of a depressed mood for 4 months. During the interview, she gives very long, complicated explanations and many unnecessary details before finally answering the original questions.

Which of the following psychiatric findings best describes this style of train of thought?

a. Loose association
b. Circumstantiality
c. Neologism
d. Perseveration
e. Flight of ideas

The answer is b.  Circumstantiality indicates the loss of a goal-directed thought process: the patient brings in many irrelevant details and comments, but eventually will get back to the point. In loose associations, the thought process has also lost its goal-directedness;

however, the patient never gets back to the original point and there is no clear connection between sentences. A neologism is a fabricated word made up by the patient, which is usually a combination of existing words.

Perseveration, often associated with cognitive disorders, refers to a response that persists even after a new stimulus has been introduced—for example, a patient asked to repeat the phrase “no ifs, and, or buts” responds by saying, “no ifs, ifs, ifs, ifs.” Flight of ideas is a disorder of thinking in which the patient expresses thoughts very rapidly, with constant shifting from one idea to another, though the ideas are often connected.

Wednesday, February 24, 2016

history of difficulty breathing during feeding-DrSudeepKC

A 2-week-old full-term infant is brought to the ED with a history of difficulty breathing during feeding.
Examination reveals a noncyanotic, tachypneic infant. The heart rate is 140/min, and you can easily hear a widely radiating systolic murmur.

Chest radiography shows cardiomegaly and pulmonary congestion. The child most likely has:
a. Patent ductus arteriosus.
b. Hypoplastic left ventricle.
c. Coarctation of the aorta.
d. Transposition of the great vessels.
e. Ventricular septal defect.

The answer is c. The first step in evaluating heart disease in the infant is to establish whether it is cyanotic or acyanotic. In the infant with heart failure, the diagnosis is aided by knowledge of the time course. Immediately after birth, congestive heart failure (CHF) is most often caused by noncardiac diseases such as hypoxia, hypoglycemia, hypocalcemia, acidosis, and sepsis.

Patent ductus arteriosus is the most common cause of CHF in premature infants, but hypoplastic left ventricle is the most common cause of CHF in the term infant’s first week. Coarctation commonly presents as acute CHF in the second week.

Transposition of the great vessels usually occurs in the first 3 days with cyanosis and failure. CHF due to a ventricular septal defect usually presents approximately 1 month after birth. After 3 months, CHF is most likely due to acquired diseases like myocarditis, anemia, and rheumatic

Monday, February 22, 2016

२ दिन देखी पेट दुखाई सहन नसक्नु हुदै गयो -डा .सुदिप के सी

A 58-year-old man has a long history of dyspepsia for which he frequently takes over the counter antacids.

For the past 2 days his epigastric pain is worse and is constant.

Vital signs: oral temperature 99.0◦F,
heart rate 110/min,
blood pressure 158/90 mmHg.
His abdomen is rigid and you note decreased bowel sounds.
The x-ray showed in Figure  was obtained. Your next step would be to:

a. Perform an immediate paracentesis.
b. Consult surgery for perforated hollow viscus.
c. Give oral contrast and take to CT scan for further evaluation.
d. Start a proton pump inhibitor and refer to a gastroenterologist.
e. Begin high-dose somatostatin therapy and consult gastroenterology.

The answer is b: This upright chest x-ray shows free air under the diaphragms, consistent with perforated peptic ulcer. PUD is common in the United States but only 7% experience perforation. Ninety-five percent of these patients will require emergent operative intervention. The upright chest x-ray is approximately 70% sensitive for detecting perforation from peptic ulcer disease. Although, instillation of 500 mL of air, or lateral decubitus films may help improve the sensitivity, CT abdomen (either no contrast or with oral contrast) is the next best test if perforation is suspected and the initial x-ray is negative.

Friday, February 19, 2016

Time onset of Echo detection after MI ? -DrSudeepKC

How long after coronary artery occlusion can echocardiography detect wall-motion abnormalities?

(A) Within a few heartbeats
(B) 5 to 10 min
(C) 30 min
(D) 1 h
(E) 2 to 4 h

The answer is A. Soon after the onset of myocardial ischemia, muscle contraction is impaired. This may manifest on echocardiography as a wall-motion abnormality.

Experimentally, hypokinesis, akinesis, or dyskinesis can be seen within a few heartbeats after coronary occlusion. In selected patients in the critical care unit, echocardiography has a sensitivity greater than 70 percent in AMI.

 In studies of ED patients, where prevalence of AMI is lower and prevalence of coronary artery disease is higher, echo has been shown to be sensitive but not specific.

Echocardiography is most useful in patients with cardiogenic shock to diagnose anatomic complications that may be amenable to surgical correction (i.e., septal or mitral ruptures).

Sunday, February 14, 2016

जीका भाईरस (zika virus) : DrSudeepKC

जीका भाईरस (zika virus)   

डा. सुदिप के .सी. MD
मानिसमा जीका भाइरस संक्रमित एडिस (ades) लामखुट्टेको टोकाइले सर्ने गर्छ ! यो लामखुटेले राती भन्दा दिनमा टोक्ने गर्छ ! यो भाइरस नेपाल बाहिर को मुलुक जस्तै अफ्रिकी मुलुक , अमेरिका , हाईटि र ब्राजिलमा देखा परिसकेको छ हालै चीनमा पनि देखिएको आशंका गरिएको छ !   नेपालमा अहिले सम्म देखा नपरेपनि फैलन सक्ने सम्भावना र फैलिएमा महामारीको रुप लिन सक्ने अनुमान गरिएको छ   !

कसरी सर्छ जीका ?
1.       लामखुट्टेको टोकाइले
2.       पहिले नै संक्रमित रक्तदान गर्दा
3.       शारिरिक सम्पर्क गर्दा
4.       गर्भवती आमाबाट पेटको बच्चामा
5.       बच्चालाई दुध खुवाउदा

रोगका लक्षणहरु
·         लक्षणहरु मुख्य रुपमा लामखुट्टेले टोकेको २ देखि १२ दिन मा देखिन्छ !
·         बिरामीलाई रोग लागेको थाहा नहुन सक्छ जसलाई असिमटोमेटिक(asymptomatic) भनिन्छ!
·         तल उल्लेखित २ वा २ भन्दा बडी लक्षणहरु रहेमा बिरामी जीका भाइरस संक्रमित भन्न सकिन्छ !
o   हल्का ज्वरो आउने
o   शरिरमा बिबिरा आउने
o   मासपेसी दुखने
o   टाउको दुख्ने
o   आखा पछाडिको भाग दुख्ने
o   पेट दुख्ने
o   पातलो दिसा ३ पटक भन्दा बडी हुने
o   वाकवाक लाग्ने
o   मुखको छालाहरु खोल्सिदै जाने
o   शरिर चिलाउने
o   माथिका लक्षणहरु २ देखी ७ दिन मा हराएर जाने
रोग लागेपछि के के खराब गर्छ  ?
·         बच्चाको टाउको सानो हुने जसलाई माइक्रोसिफेली  (microcephaly) भनिन्छ !
·         आँखा भित्र रहेको नसा सुकेर हेर्न नसक्ने हुने !
·          खुट्टा कम्जोर भई बिस्तारै माथी सर्दै पुरा शरिर कम्जोर भई स्वास फेर्न नसक्ने र मृत्यु हुने !

 के-के जाचहरु गरेर पत्ता लाग्छ त जीका लागेको ?
·         नेपालमा र धेरै प्रमुख देशहरुमा अजै पनि टेस्ट उपलब्ध हुन सकेको छैन !
·         तर  अमेरीकी हेल्थ ओर्गनैजेशन ,WHO, CDC ,अर्बो भाईरस डाईगोनोस्टिक ल्याब र स्टेट हेल्थ ल्याब  अहिले सम्मका जाच गर्ने यी मात्र ठाउँहरु हुन् जहाँ जीका टेस्ट गर्न सकिन्छ !  
·         लक्षण भएको  ७ दिन भित्र रगत आर टि पी सि आर (RT-PCR) मध्यम बाट जाच गर्न सकिने !
·         जीका भाइरस सेरोलोजिकल नै प्रमाणित जाच हो (CONFIRMATORY) !
·         ७ दिन पछि आउने बिरामीलाई दुवै  आर टि पी सि आर र सेरोलोजिकल गर्नु पर्ने !
पेटमा बच्चा हुदा महिलाको जाच
यदि महिला लाई जीका संक्रमित भएमा अर्थात् माथि लेखिएका लक्षण देखिएमा
·         संक्रमित भएको  २ देखी १२ हप्ता भित्र ल्याब जाच
·         जचमा केही थाहा नभएमा वा नेगेटिव भएमा बच्चा बसेको ठाउँ (साल) र बच्चाको जाच गर्नु पर्ने !
·         भिडियो X-रेय गरि बच्चाको सानो टाउको वा गिदीमा सेतोपदार्थ (क्याल्सिफिकेसन) भएको अवस्था पत्ता लगाउने !
·         यदी बच्चाको टाउको सानो भएमा र गिदीमा सेतोपदार्थ (क्याल्सिफिकेसन )भएमा बच्चा बसेको सालको
परिक्षणहरु गर्ने !

यदि महिला लाई जीका संक्रमित नभएमा अर्थात् माथीलेखिएका लक्षण नदेखिएमा
·         संक्रमित नभएको महिलाको ल्याब जाच गर्न नपर्ने 
·         जचमा केही थाहा नभएमा वा नेगेटिव बच्चा बसेको ठाउँ र बच्चाको जाच गर्नु पर्ने
·         भिडियो X-रेय ३-४ हप्तामा  गरि बच्चाको टाउको वा गिदीको  अवस्था पत्ता लगाउने !
·         यदी बच्चाको टाउको सानो भएको  र गिदीमा सेतोपदार्थ (क्याल्सिफिकेसन )भएको शंका लागेमा  बच्चा बसेको सालको परिक्षणहरु गर्ने !
बच्चा भैसकेकोमा कसरी जीका संक्रमित छ छैन पत्ता लगाउने ?
·         बच्चा ६ महिना पुगेपछि बच्चाले कान सुन्छ कि सुन्दैन जाच गर्ने !
·         बच्चालाई नजिकको स्वस्थ चौकी वा डाक्टरकोमा लगी बच्चाको सुन्ने शक्तिको जाच गर्ने !
·         अरू बच्चाको तुलनामा आफ्नो बच्चा हुर्केको अवस्थाको ख्याल गर्ने र बच्चाको टाउकोको गोलाई पहिलो वर्ष सम्म नाप्ने !
उपचार कसरी गर्ने ?
·         पहिले लक्षणहरूको अवस्था र अवस्था अनुरूप औषधी दिने !
·         ज्वरो आएमा आराम गर्ने , झोल पदार्थ र सिटामोल दिने !
·         एसप्रिन र ब्रुफेंन जस्ता औषधी नदिने जब सम्म डेंगु ज्वरो भएको नभएको थाहा हुदैन !
रोकथाम कसरी  गर्ने ?
गर्भवती महिला जीका भाइरस संक्रमित भूभागमा नजाने !
अहिले सम्म कुनै पनि भ्याक्सिन छैन तर भारतीय कम्पनी बायोटेकले २ वोटा भ्याक्सिन भएको दाबी गर्दै आएको छ तर अहिले सम्म त्यसको असर र कुनै पनि अध्ययन भएको छैन र अहिले सम्म मान्छेमा प्रयोग गरिएको छैन  !
लामखुटटे  को टोकाइबाट बच्नेनै मुख्य रोग हुनु बाट जोगिनु हो !
घरमा जाली ढोका र सुत्दा जाली प्रयोग गर्ने लामखुटटेबाट बच्ने मल्हम पनि प्रयोग गर्न सकिन्छ !
कुनैपनि कपडा फोहोरो र शंका लागेमा लामखुटटे मार्ने स्प्रे प्रयोग गर्न सकिन्छ !
बच्चालाई शरिर पुरा छोप्ने लुगा लगाउने र लामखुटटे  भएको ठाउँमा जान वा खेल्न नदिने !

Saturday, February 13, 2016

failed her end-of-year exams and had ended a long-term relationship earlier that week -DrSudeepKC

A 19-year-old student has been admitted to hospital after being found unconscious in
her room in university halls of residence.

Her room-mate told the paramedics that she had recently failed her end-of-year exams and had ended a long-term relationship earlier that week.

She is not known to have any medical history and took occasional painkillers for a knee injury. She was found with several empty packets of paracetamol around her.
A suicide note was discovered next to her.

The student is drowsy but responsive. She admits to taking thirty 500 mg paracetamol
tablets and eight 30 mg codeine phosphate tablets with a bottle of wine approximately
4 hours earlier. Observations: temperature 36.4°C, heart rate 80/min, blood pressure
110/70 mmHg, respiratory rate 12/min, SaO2 96 per cent on room air.

• What are the consequences of a paracetamol overdose?
• How should this young person be managed acutely?

Paracetamol overdose is the leading cause of acute liver failure in the United Kingdom.
Paracetamol is metabolized to N-acetyl-p-benzoquinoneimine (NAPQI), which depletes
the liver’s glutathione stores. Glutathione is an antioxidant and protects the hepatic cells
from damage. High levels of NAPQI can build up after a paracetamol overdose and subsequently
lead to liver failure. Liver failure can develop over hours, or even days. In this
case, the patient has also taken opoid medication (codeine phosphate), which may further
impair hepatic function.

In some centres, activated charcoal may be given if the patient presents within an hour
of taking the overdose. This is a very porous substance and can adsorb substances such
as paracetamol, reducing the levels that enter the bloodstream.

Over the first 24 hours, patients can experience nausea and sweating. Blood tests should
be sent to monitor the liver function, and they classically show a hepatitic picture with
raised transaminases. Liver synthetic function should be monitored closely. The liver
produces coagulation factors, and measuring the international normalized ratio (INR) will
indicate how effective the liver is at synthesizing these products. A persistently high INR
is an indication for a liver transplant. Renal function should also be closely monitored,
as an acute kidney injury can occur.

After 3–5 days, patients are at risk of hepatic necrosis. Patients can present with sepsis,
impaired clotting function and multi-organ failure.

Patients should have regular observations performed and be kept in a bed where they
can be monitored. Intravenous fluid rehydration should be given. In addition to the
aforementioned blood tests, blood glucose checks should also be performed, as patients
can become hypoglycaemic in liver failure. Serum paracetamol levels should be taken to
confirm the diagnosis and help guide treatment.

The mainstay of treatment is N-acetylcysteine, which replenishes the stores of glutathione
and prevents further liver damage. This treatment can be very effective if given
within 8 hours of the overdose. Some people can have an anaphylactoid reaction to
N-acetylcysteine, so the person must be very closely monitored.

In the longer term, the patient should have a psychiatric review to assess her risk of further
suicide attempts and to identify an underlying depressive illness.

Wednesday, February 10, 2016

he is found seizing on the floor-DrSudeepKC

he is found seizing on the floor 

A 54-year-old man with past medical history of HIV, hypertension, and tuberculosis is brought to the
emergency department by a family friend after he is found seizing on the floor .

The seizures persist despite the administration of appropriate doses of benzodiazepines. Serum glucose is normal.

The next agent you should give is:

a. Phenytoin.
b. Barbiturates.
c. Pyridoxine.
d. Etomidate.
e. Propofol.

The answer is c. All of the agents listed are useful in treating seizures. In patients with a history of tuberculosis, status epilepticus should be considered secondary to isoniazid toxicity until proven otherwise. In overdose, isoniazid causes confusion, agitation, seizures, and acidosis. It depletes the body of vitamin B6 (pyridoxine) leading to a reduction of gamma-aminobutyric acid (GABA) in the central nervous system. GABA acts as an important inhibitory neurotransmitter, therefore depletion leads to unopposed CNS excitation.

The treatment of an acute INH overdose in an adult is 5 g of pyridoxine given intravenously. The dose in children is 70 mg/kg. One dose of pyridoxine has virtually no risk of toxicity and should be given empirically in the setting of status epilepticus when
there is any possibility of an INH exposure. 

Tuesday, February 9, 2016

The average duration of a tonic–clonic seizure is-DrSudeepKC

The average duration of a tonic–clonic seizure is

a. 15 seconds.
b. 28 seconds.
c. 60 seconds.
d. 120 seconds.
e. 148 seconds.

The answer is c. In a typical tonic–clonic seizure, electroencephalogram changes last an average of 59.9 seconds, and behavioral changes last only a few second longer. Thus, a seizure lasting 5 minutes is more than 17 standard deviations beyond the “typical” seizure.

A 40-year-old man complains of a unilateral periorbital headache accompanied by rhinorrhea and
lacrimation. The most effective abortive therapy to treat this headache seems to be:

a. Transnasal sumatriptan.
b. High-flow oxygen using a nonrebreather mask.
c. Intravenous ketorolac.
d. Valsalva maneuver while squatting.
e. Papaya juice.

The answer is b. Cluster headaches share with migraine headaches of a vascular origin and recurrent nature. Men are afflicted far more often than women. The age of onset, unlike that of migraine, is usually the mid-thirties to mid-forties. There is no aura, nausea, or vomiting. A cluster headache has recurrent characteristics of time, location, and duration. The pain has a boring quality and localizes to the frontal region. Unlike a migraine headache, it does not become bilateral or extend posteriorly to the scalp. A nocturnal onset is a characteristic but not invariable finding. Accompanying autonomic signs include ipsilateral lacrimation, rhinorrhea, and flushing. Intranasal drugs are usually not well absorbed because of the mucosal swelling. High-flow oxygen therapy using a nonrebreather
mask can abort the attack in less than 1 minute.

Monday, February 8, 2016

24-year-old woman who was recently treated for vaginal discharge--DrSudeep KC

A 24-year-old woman who was recently treated for vaginal discharge now returns after she received a letter telling her that she had a positive VDRL. She recalls having had a painless ulcer 5 or 10 years ago that resolved without treatment. She has no complaints or physical findings on your examination.

What is the treatment of choice for this patient?

a. Benzathine penicillin G, 2.4 million units IM weekly for 3 weeks.
b. Benzathine penicillin G, 2.4 million units IM daily for 14 days.
c. Aqueous crystalline penicillin G, 50,000 U/kg IV every 6 hours for 3 weeks.
d. Procaine penicillin, 2.4 million units IM daily for 10–14 days and probenecid 500 mg orally 4 times daily for 17–21 days.
e. Benzathine penicillin G, 2.4 million units IM, one dose only.

The answer is a. Because she has likely had syphilis for longer than 1 year, this patient has late latent syphilis.
During latent syphilis, there are no clinical symptoms and laboratory testing is the only means of identification.

The positive VDRL should be confirmed with subsequent fluorescent treponemal antibody absorption (FTA-ABS) tests. Treatment with benzathine penicillin G 2.4 million units IM weekly for 3 weeks should be initiated. The patient should be advised to undergo HIV testing and her sexual partners should be evaluated for syphilis. Choice d is an acceptable treatment for neurosyphilis.

Thursday, February 4, 2016

Tongue Swelling in a Hypertensive Female--DrSudeepKC

Tongue Swelling in a Hypertensive Female

A 60 - year - old female with a history of hypertension presents to the emergency department
with a complaint of progressive tongue swelling over the past 8 hours. She denies a change in diet, insect  envenomation, or exposure to any new pets, detergents, or perfumes. She also denies any recent changes in medications.

Currently, she is taking one prescription medication for her hypertension: lisinopril. She denies having diffi culty breathing and is able to swallow her secretions. 

She reports one previous episode 1 week ago of lesser severity that spontaneously resolved. Her examinatio is signifi cant for the marked tongue edema noted in the picture along with an inability to fully retract her  tongue back into her mouth. 

The rest of her examination is unremarkable.

 What is the next most appropriate management strategy at this time?
A. Reassurance and discharge to home with a prescription for a first - generation cephalosporin

B. Emergent oral surgery consultation, blood cultures, and administration of a third - generation

C. Admission to a monitored unit for observation, cessation of her lisinopril, and initiation of
antihistamines and corticosteroids

D. Computed tomography (CT) scan of the neck with intravenous contrast to evaluate for an abscess, and consultation with the ear – nose – throat service for emergent incision and drainage

E. Chest CT to evaluate for a potential lesion obstructing venous drainage from the head through
the superior vena cava

Answer: C
Diagnosis: Angioedema secondary to angiotensin - converting enzyme inhibitor
Discussion: Angioedema is a condition marked by nondependent, asymmetric edema of the deep dermal and subcutaneous tissues, commonly involving the face, lips, tongue, and oropharynx. Edema results from a loss of vascular integrity and bradykinin - mediated extravasation of fluid into the interstitial tissues.

Histamine - mediated angioedema (HMA) is typically associated with urticaria formation (a more superficial process) and, like anaphylaxis, involves both hypersensitivity and IgE - mediated allergic reactions. These reactions result in the release of histamine and other mediators from mast cells typically from exposure to food and drug allergens, as well as Hymenoptera envenomations and
physical precipitants (e.g., cold and exercise). 

Both acute cases (lasting < 6 weeks) and chronic cases (lasting > 6 weeks) have been described. Management of HMA begins with rapid identifi cation and stabilization of airway compromise
and hemodynamic instability, coupled with the immediate removal of an offending agent. Additionally, antihistamines and corticosteroids are useful. Epinephrine remains the treatment of choice for any airway compromise or vasomotor instability. The absence urticaria and/ or pruritis should prompt a clinician to consider causes of non - HMA.

Non - HMA, or bradykinin - mediated angioedema (BKMA), is thought to occur independently of mast celldegranulation and thus in the absence of urticaria and pruritis. Excess bradykinin and substance P activity have been implicated in disruption of vascular tone and permeability  associated with BKMA. Both drug - induced and hereditary angioedema are known to produce BKMA. The most common cause of BKMA presenting to emergency  rooms is exposure to angiotensin - converting enzyme inhibitor (ACEI). The incidence of BKMA with ACEI is highest in the fi rst month of therapy (25%), but it can develop years after uneventful use (overall incidence
0.1 – 0.7%). ACEI - induced BKMA is more common in older patients, females, those with diabetes, and African - Americans. ACEI - induced BKMA is not related to the development of ACEI - induced cough.

Hereditary BKMA (HAE) is an autosomal - dominant disorder involving a defi ciency in the C1 - esterase inhibitor that affects fewer than 200,000 people in the USA. HAE typically presents in childhood and is associated with a family history. Traumatic or stressful situations can lead to a transient elevation in bradykinin levels resulting in edema of the airway, face, genitalia, and extremities.

Abdominal pain is a common complaint. Acquired, functional defi ciencies in C1 - esterase activity also exist and are commonly associated with malignancy and older age. Similar to the treatment of HMA, BKMA requires particular focus on the patient ’ s airway and vasomotor stability.
Epinephrine (adrenaline) and defi nitive airway management (endotracheal intubation or surgical airway) are required for any airway or circulatory compromise.

Aerosolized racemic epinephrine, antihistamines, and corticosteroids may have some benefi t, and their administration should be considered in patients with BKMA.

Avoidance of ACEIs and close observation for progression is essential. The treatment of choice for acute presentations of HAE is fresh frozen plasma or C1-esterase inhibitor concentrate. In addition, androgens (stanozolol and danazol) have been used to prevent and treat this condition in the acute setting. Investigational agents including C1-inhibitor replacement protein, ecallantide
(DX88; a kallikrein inhibitor capable of preventing the formation of bradykinin), and icatibant (a bradykinin receptor-2 antagonist are exciting future possibilities.

कोलेस्ट्रोल भएको कसरी थाहा पाउने -DrSudeepKC

कोलेस्ट्रोल भएको कसरी थाहा पाउने


कोलेस्ट्रोलको मात्रा भनेको के हो ?
कोलेस्ट्रोल रगतमा भएको बोसो ( लिपिड ) को एक प्रकार हो । यसको उत्पादन कलेजोमा हुन्छ र रगतको माध्यमबाट कोषहरू सम्म पुग्दछ । यो आबस्यक छ तर रगतमा आवश्यकता भन्दा बढी मात्रामा  कोलेस्टेरोल रहेमा यसले शरीरलाई नराम्रो असर गर्दछ । आबस्यकता भन्दा बढी कोलेस्ट्रोलले मुटुका धमनीको भित्री भित्तामा जम्मा भई नसा साँघुर्‍याएर रक्तप्रवाहमा अवरोध पुर्‍याउँछ । यसरी कोलेस्ट्रोलको कारणले धमनी बन्द हुन् गएमा वा साँघुरिएमा त्यसबाट मुटु दुख्ने (ऐँठन हुने ) तथा पक्षघातजस्ता समस्या देखापर्न शुरु गर्दछ । बेलैमा शाबधानी नअपनाउने हो भने जीवन जोखिममा पर्ने वा अपाङ्गसमेत हुन सक्छ । कोलेस्ट्रोल फरक प्रकारका हुन्छन, LDL कोलेस्ट्रोललाई नराम्रों मानिन्छ भने HDL लाई राम्रों मानिन्छ । LDL कोलेस्ट्रोल छ भने हृदयघात तथा स्ट्रोकको जोखिम हुन्छ ।
कोलेस्ट्रोल नाप्न किन जरुरी छ ?
कोलेस्ट्रोल स्वयंमा बिरामीको रुपमा नदेखिने भएता पनि यसको साथमा ब्लडप्रेसर, डायबिटिज, उमेर, लिंग, जात, धुम्रपान गर्ने-नगर्ने जस्ता कुराहरुबाट सम्बंदित व्यक्तिलाई हृदयघात, स्ट्रोकको खतराको स्तर निकाल्नको लागि यसको जाच गर्न जरुरी छ ।
कोलेस्ट्रोलको मात्रा के ले बढाउछ ?
धेरै बोसो, ट्रान्स बोसो तथा कोलेस्ट्रोलको मात्रा खानाले
कसरत नगर्ने गर्नाले वा शारीरिक परिश्रम नपर्ने काम गर्नाले
तौल बढ्दा शरीरमा भएको राम्रों कोलेस्ट्रोल घट्दै जान्छ र नराम्रो बढ्दै जान्छ 
पारिवारिक पृष्ठभूमि- यदि तपाइंको परिवारमा कसैलाई कोलेस्ट्रोल छ भने तपाईलाई पनि हुने सम्भावना बढी हुन्छ
साधारणतया २० बर्षको उमेर पश्चात नराम्रो कोलेस्ट्रोल बढ्न सक्दछ 
कोलेस्ट्रोलको रिपोर्ट कसरी थाहा पाउन सकिन्छ ?
कोलेस्ट्रोलको स्तर बढेको बिरामीले महसुस गर्दैन । रगत परीक्षण गराउनु नै कोलेस्ट्रोलको स्तर थाह पाउने तरिका हो । रगत परिछण पश्चात आएको रिपोर्टलाई विभिन्न श्रोतमा बताइए अनुसार निम्नानुसार विभाजन गरि बुझ्न सकिन्छ; यस सम्बंदी बिस्तृत निर्क्यौल गर्ने काम भने सम्बंदित डाक्टरले गर्नेछन ।
Total Cholesterol
२०० mg./dl भन्दा कम – सन्तोषजनक अबस्था
२०० देखि २३९ mg/.dl – खतरा शुरु हुन लागेको
२४० mg./dL m वा बढी – खतरनाक अबस्था
LDL Cholesterol
LDL को मात्राले हृदयघातको खतरालाई Total Cholesterol भन्दा राम्रोसँग प्रतिविम्बित गर्छ ।
१०० mg/.dl भन्दा कम - सन्तोषजनक अबस्था
१०० देखि १२९ mg/.dl - खतरा शुरु हुन लागेको
१३० mg/.dl वा बढी - खतरनाक अबस्था
HDL Cholesterol
सामान्यतया महिलामा ५०–६० mg/dl र पुरुषमा ४०–५० mg/dl हुनुपर्ने मान्यता छ। HDL कम भएमा हृदयघातको खतरा बढ्छ।
४० mg./dl भन्दा बढी - सन्तोषजनक अबस्था
४० mg/dl नरमी भन्दा कम - खतरनाक अबस्था

बेलैमा आफ्नो रगत परिछण गराई ढुक्क हुनुहोस । तपाईले दैनिक  शारीरिक अभ्यास वा योगा गर्ने, बोसो रहित खाना खाने, धुम्रपान नगर्ने, शरीरको तौल बढ्न नदिई रोकथाम गर्न सक्नु हुन्छ ।

Wednesday, February 3, 2016

sinusitis presents with a severe headache- Dr.Sudeep K.C.

A 46-year-old woman with a history of sinusitis presents with a severe headache. She complains of
neck stiffness and photophobia. 

On physical examination , she has a temperature of 103.4°F. Blood pressure is normal and heart rate is 110/min. She has a normal funduscopic examination and no focal neurologic deficit. She has nuchal rigidity.

Brudzinski and Kernig  signs are positive.

Which of the following is the most likely diagnosis?

a. Migraine headache
b. Cluster headache
c. Torticollis
d. Bacterial meningitis
e. Cysticercosis
f. Fever of unknown origin

The answer is d.   The patient is demonstrating signs of meningeal irritation. She has nuchal rigidity,
a positive Brudzinski sign (involuntary flexion of the hips and knees when flexing the neck), and a positive Kernig sign (flexing the hip and knee when the patient is supine, then straightening out the leg, causes resistance and back pain). Other signs of meningitis include headache, photophobia, seizures, and altered mental status. Patients with meningitis (<1%) rarely have papilledema secondary to increased intracranial pressure.
Risk factors for meningitis include sinusitis, ear infection, and sick contacts. Fever of unknown origin (FUO) is defined as a fever of >101°F for 3 wk that remains undiagnosed after 1 wk of aggressive investigation.

Tuesday, February 2, 2016

Pathology’s top ten one liners.......& what they really mean- DrSudeepKC

Pathology’s top ten one liners.......& what they really mean

1) Enucleated specimen of right eye, inadequate for opinion: excise the left eye, too.

2) Small round cell tumour, advised immunohistochemistry for a definite diagnosis: I don’t know what the hell it is.

3) Compatible with lichen planus: doesn’t look like it. But if you insist, I don’t resist.

4) Florid reactive hyperplasia, lymph node; advised close clinical follow up: boss, wait till it turns into a full blown lymphoma, then I’ll type it.

5) Borderline serous cystadenoma, ovary, with focal microinvasion: phew, this’ll save my skin, if the patient throws a met 10 years later!

6) Early ill formed epithelioid granulomas with occasional acid fast bacilli: I have an excellent imagination!

7) Special stains for fungi, bacteria and parasites are not contributory: I didn’t look hard enough.

8) Metastatic poorly differentiated neoplasm, cerebellum, with possibilities of carcinoma, sarcoma, melanoma, lymphoma . . .: looking for the primary is your job; anyway, how does it matter now?

9) Appendix showing lymphoid hyperplasia: you knocked off a perfectly normal one.

10) Poorly preserved biopsies from multiple sites, unsuitable for definite opinion: only a necropsy can solve the issue!

bee sting- DrSudeepKC

The recommended initial therapy for a patient suffering a severe allergic reaction to a bee sting is:

The recommended initial therapy for a patient suffering a severe allergic reaction to a bee sting is:

a. Albuterol.
b. Cimetidine.
c. Dopamine.
d. Epinephrine.
e. Norepinephrine.

The answer is d. Epinephrine is the hallmark of anaphylaxis management. Cold compresses, antihistamines, nonsteroidal anti-inflammatory agents, and corticosteroids are indicated in localized reactions from hymenoptera stings.

a patient who is in acute pulmonary edema-DrSudeepKC

You are managing a patient who is in acute pulmonary edema, with cool clammy skin. His blood pressure is 84/56 mmHg. The medication of choice in this patient would be:

a. Epinephrine.
b. Dobutamine.
c. Vasopressin.
d. Phenylephrine.
e. Norepinephrine.

The answer is b. This patient is presenting with cardiogenic shock. In this case, to improve myocardial contractility,dobutamine and dopamine are the agents of choice begun in order at the same doses used for septic shock.