Publications by authors named "Suraj Shrestha"

30 Publications

  • Page 1 of 1

Adrenal Leiomyoma: A case report.

Int J Surg Case Rep 2021 Jul 29;85:106249. Epub 2021 Jul 29.

Department of Pathology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.

Introduction And Importance: Adrenal Leiomyomas are infrequent tumors with only a few cases reported to date. They are difficult to differentiate from malignant adrenal tumors due to non-specific findings on clinical examination and imaging studies.

Case Presentation: We discuss the case of a 49-year old male who had been experiencing generalized abdominal pain for 14 months and was found to have a mass on ultrasonography. Further evaluation with Contrast-enhanced Computerized Tomography (CECT) revealed an uneven soft tissue density mass in the retroperitoneal region of the left side. The histopathological examination of the excised mass was suggestive of a mesenchymal tumor, which was further confirmed as leiomyoma by immunohistochemistry.

Clinical Discussion: Adrenal Leiomyomas are rare smooth muscle tumors that present with heterogeneously enhancing mass on radiologic imaging. On histopathological examination, spindle cells arranged in lobules and fascicles can be appreciated. Positive staining for desmin and smooth muscle actin in immunohistochemistry confirms the diagnosis.

Conclusion: Identification of the type of tumor in any adrenal mass is challenging pertaining to the non-specific findings on imaging studies. So, prompt surgical resection is the mainstay of the treatment.
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http://dx.doi.org/10.1016/j.ijscr.2021.106249DOI Listing
July 2021

Rebleeding in aneurysm after rectal enema: Re-emphasis on careful subarachnoid hemorrhage management.

Clin Case Rep 2021 Jul 23;9(7):e04538. Epub 2021 Jul 23.

Kathmandu Medical College and Teaching Hospital Kathmandu Nepal.

Rebleeding in an aneurysmal subarachnoid hemorrhage (SAH) is catastrophic with high mortality and grave outcome. Meticulous management of SAH patients and the prevention of activities that might increase the chances of rebleeding are life-saving.
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http://dx.doi.org/10.1002/ccr3.4538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299095PMC
July 2021

Cyclopia with proboscis: A rare congenital anomaly.

Clin Case Rep 2021 Jul 16;9(7):e04466. Epub 2021 Jul 16.

Department of Obstetrics and Gynecology Tribhuvan University Teaching Hospital Kathmandu Nepal.

Cyclopia with a proboscis, a rare congenital anomaly, and a severe form of holoprosencephaly occur as a result of incomplete separation of prosencephalon into two halves of hemispheres during organogenesis. A prenatal anomaly scan can help in the early detection of the condition and timely termination of the pregnancy.
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http://dx.doi.org/10.1002/ccr3.4466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8283846PMC
July 2021

Biotransformation of Daidzein, Genistein, and Naringenin by Species Isolated from High-Altitude Soil of Nepal.

Int J Microbiol 2021 19;2021:9948738. Epub 2021 Jun 19.

Department of Chemical Science and Engineering, Kathmandu University, Kathmandu, Nepal.

Flavonoids have achieved widespread importance in pharmaceutical, food, and cosmetics industries. Furthermore, modification of these naturally occurring flavonoids to structurally diverse compounds through whole cell biotransformation with enhanced biological activities has numerous biotechnological applications. The present study investigated the biotransformation potential of species isolated from a high-altitude-soil sample towards selected flavonoid molecules. The biotransformed metabolites were confirmed by comparing the HPLC chromatogram with authentic compounds and LC-MS/MS analysis. Of these isolates, species G-18 (Accession number: MW663767.1) catalyzed isoflavone molecules daidzein and genistein to produce hydroxylated products at 24 h of reaction condition in a whole cell system. The hydroxylation of daidzein (4',7-dihydroxyisoflavone) was confirmed at 3'-position of the B ring to produce 3',4',7-trihydroxyisoflavone. In addition, species G-14 (Accession number: MW663770.1) and species S4L (Accession number: MW663769.1) also revealed the transformation of daidzein (4',7-dihydroxyisoflavone) to hydroxy daidzein at a distinct position than that of G-18 isolates, whereas thee species S4L reaction mixture with naringenin as a substrate also revealed the hydroxylated product. Our results demonstrated that microorganisms isolated from different ecological niches have broad application.
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http://dx.doi.org/10.1155/2021/9948738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8238566PMC
June 2021

Symptomatic familial adenomatous polyposis in an adolescent: A case report.

Int J Surg Case Rep 2021 Jul 26;84:106118. Epub 2021 Jun 26.

Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal.

Introduction: Familial adenomatous polyposis (FAP) is an inherited colorectal cancer syndrome characterized by several adenomatous polyps of the gastrointestinal mucosa with a universal risk of colorectal cancer in a lifetime. FAP is usually asymptomatic in the first decade of life.

Case Presentation: We report a case of a 13-year-old girl diagnosed with FAP who presented in our center with symptoms of hematochezia along with a positive history of the untimely demise of her father and elder sister with similar symptoms.

Discussion: FAP is an autosomal dominant disease affecting both male and female equally with variable penetrance. Diagnosis is made by finding hundreds to thousands of adenomatous polyps in the colon and rectum, and molecular analysis of the APC gene which forms the definitive diagnosis. Prophylactic laparoscopic total proctocolectomy with ileorectal anastomosis is a safe and feasible surgical option with a low risk of complications among adolescents. An endoscopic/colonoscopic procedure is recommended every 6 to 12 months after surgery to assess the anastomosis site, pouch, and residual rectum.

Conclusion: FAP, a rare disease entity in adolescents should be managed by appropriate diagnostic procedures, early prophylactic surgery, and regular lifelong follow-up.
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http://dx.doi.org/10.1016/j.ijscr.2021.106118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8254105PMC
July 2021

Cecal gastrointestinal stromal tumor causing ileocolic intussusception in an adult: A rare case report.

Int J Surg Case Rep 2021 Jul 8;84:106097. Epub 2021 Jun 8.

Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.

Introduction And Importance: Cecal gastrointestinal stromal tumors (GIST) constitute a rarer subtype of all GISTs. Rarely, it can present with ileocolic intussusception in adults making it a challenging diagnosis due to non-specific clinical features.

Case Presentation: A 30-year previously healthy woman presented with lower abdominal pain and a distended abdomen who was subsequently diagnosed with ileocolic intussusception on a CT scan. Intraoperatively, a pedunculated polypoid hard mass was identified in the cecum and thus, a standard right hemicolectomy was performed with the suspicion of malignancy. Histopathology of the resected mass confirmed CD117 negative, spindle type GIST.

Discussion: Cecal GIST presenting in the form of ileocolic intussusception is rare. Contrast-enhanced CT scan is the preferred imaging modality for the evaluation of patients with suspected GIST to determine the extent of the tumor, the presence or absence of metastatic disease alongside evaluation of the possibility of complete resection. Adjuvant imatinib therapy following complete resection decreases the disease recurrence.

Conclusion: Intussusception in an adult can be the first manifestation of underlying malignancy like GIST. Complete surgical resection of the tumor with a negative margin offers long-term survival.
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http://dx.doi.org/10.1016/j.ijscr.2021.106097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8219755PMC
July 2021

Hirschsprung disease with Edward syndrome: A rare association: A case report.

Int J Surg Case Rep 2021 Jul 9;84:106084. Epub 2021 Jun 9.

Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal. Electronic address:

Introduction And Importance: Edward's syndrome (ES) occurs as a result of trisomy of chromosome 18 and is associated with multisystem congenital anomalies. The association of ES with various gastrointestinal malformations but Hirschsprung disease (HD) is well documented.

Case Presentation: A female infant on her 5th day of life presented with episodes of bilious vomiting along with abdominal distension and no passage of stool. The child had a small head and prominent occiput, low set abnormal ears, small jaw, upturned nose, widely spaced eyes, small neck with widely spaced nipples, clenched hands with overlapping fingers, flexed big toe, and prominent heels.

Clinical Discussion: Edward syndrome is associated with multisystem congenital abnormalities of which gastrointestinal abnormalities make up the most part. The condition can be identified by fetal ultrasound screening. Surgical correction of associated congenital anomalies at different times along with lifelong supportive management is important.

Conclusions: Edward syndrome can present as Hirschsprung disease as a part of associated gastrointestinal Malformation. Often, early identification and termination of the pregnancy in antenatal life can reduce the suffering. Surgical correction of associated anomalies along with supportive care forms the cornerstone of management. However, the prognosis remains poor.
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http://dx.doi.org/10.1016/j.ijscr.2021.106084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8196216PMC
July 2021

Primary squamous cell carcinoma of the breast in a young female- A rare ailment.

Clin Case Rep 2021 May 24;9(5):e04214. Epub 2021 May 24.

Department of Surgery Nepal Cancer Hospital and Research Center Lalitpur Nepal.

Primary squamous cell carcinoma of the breast is an extremely rare invasive breast carcinoma with rapid progression and worse prognosis. Careful assessment and diagnosis of the entity should also be considered in a rapidly progressing breast tumor.
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http://dx.doi.org/10.1002/ccr3.4214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142402PMC
May 2021

Jejunal varices with extra hepatic portal vein obstruction: A case report.

Int J Surg Case Rep 2021 Jun 12;83:105964. Epub 2021 May 12.

Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.

Introduction And Importance: Extrahepatic portal vein obstruction (EHPVO) with portal hypertension is rare in children. Intestinal varices as new collaterals accompanying portal hypertension are very rare.

Presentation Of Case: We report an unusual case of a 12-year-old boy with EHPVO with gastrointestinal bleeding from ectopic jejunal varices, without any gastroesophageal varices.

Discussion: Portal hypertension is the most common cause of EHPVO. Among various ectopic varices, intestinal varices are found distal to the duodenum and present with complaints of hematochezia, melena, or intraperitoneal bleeding. The diagnosis of the EHPVO is aided by imaging investigations like Doppler ultrasound, computed tomography, or magnetic resonance imaging. A multidisciplinary team including gastroenterologists, interventional radiologists, surgeons, and intensivists is crucial in the management of ectopic varices.

Conclusion: Jejunal varices must be considered in the differential diagnosis of gastrointestinal (GI) hemorrhage in patients with a negative source of bleed on upper and lower GI endoscopy.
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http://dx.doi.org/10.1016/j.ijscr.2021.105964DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141758PMC
June 2021

Jejunal GIST masquerading as an ovarian mass: A case report.

Int J Surg Case Rep 2021 May 3;82:105960. Epub 2021 May 3.

Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.

Introduction And Importance: Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors originating in the wall of the gastrointestinal tract. Jejunal GIST is the rarest subtype. Large GIST can present with an abdominopelvic mass which can be preoperatively misdiagnosed as a gynecological tumor.

Case History: A 44-year regularly menstruating woman presented with lower abdominal pain which was diagnosed as a malignant ovarian tumor preoperatively with an MRI. However, intraoperatively, a lobulated mass was present in the abdominal cavity arising from a jejunal portion of the small intestine. With an intraoperative diagnosis of jejunal GIST, the mass was excised and jejunum anastomosed. Histopathology examination report showed GIST which was further confirmed by immunohistochemistry.

Discussion: GIST presenting as a large abdominopelvic mass can mimic a gynecological tumor. Contrast-enhanced CT scan is the preferred imaging modality for the evaluation of patients with suspected GIST to determine the extent of the tumor, the presence or absence of metastatic disease alongside evaluation of the possibility of complete resection. Adjuvant imatinib therapy following complete excision can decrease the disease recurrence.

Conclusion: Gynecologists should keep in mind that primary gastrointestinal tumors can present as a pelvic mass. A proper histopathological examination helps to confirm the diagnosis. Complete surgical removal of the tumor should be obtained as it determines the prognosis of the disease.
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http://dx.doi.org/10.1016/j.ijscr.2021.105960DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114170PMC
May 2021

Squamous cell carcinoma arising within choledochal cyst managed by pancreaticoduodenectomy: A case report.

Int J Surg Case Rep 2021 May 27;82:105919. Epub 2021 Apr 27.

Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.

Introduction And Importance: Choledochal cysts (CC) are rare cystic dilatation of the biliary trees. Malignancy is one of the important significant findings in CC and its incidence increases with age. Associated squamous cell carcinoma of the choledochal cyst is an uncommon pathological finding.

Case Presentation: We present a 21-year-old male diagnosed with type 1 CC and planned for excision of the cystic dilated extrahepatic biliary tract with hepaticojejunal anastomosis in Roux-en-Y but underwent pancreaticoduodenectomy due to intraoperative palpable mass of CC which was adhered to the duodenum and pancreatic head. Histopathology of the excised specimen revealed squamous cell carcinoma (SCC) of the choledochal cyst.

Discussion: CC represents a rare biliary cystic disease. Though infrequent, malignant transformation in CC includes cholangiocarcinoma, adenocarcinoma, and rarely SCC. The post-operative management for SCC in CC is ill-defined and carries a grave prognosis.

Conclusion: The choledochal cyst should be completely excised wherever possible to avoid the possible malignant transformation in CC including SCC.
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http://dx.doi.org/10.1016/j.ijscr.2021.105919DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102759PMC
May 2021

Common hepatic artery pseudoaneurysm: A rare complication following total gastrectomy: A case report.

Int J Surg Case Rep 2021 Apr 23;81:105816. Epub 2021 Mar 23.

Department of Gastrointestinal and General Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Electronic address:

Introduction And Importance: Common Hepatic Artery (CHA) Pseudoaneurysm is a rare entity, attributed to infections, trauma, and upper abdominal surgery. Most cases occur after biliary and pancreatic surgery. CHA pseudoaneurysm after total gastrectomy is uncommon and can be devastating.

Case Presentation: A 58-years male who underwent D2 total gastrectomy for gastric carcinoma ten days ago, presented with hematemesis, epigastric pain, and a history of melaena. After admission, upper gastrointestinal endoscopy showed a clot at the jejunojejunostomy site. Computed tomography with angiography was diagnostic of pseudoaneurysm of CHA located inferiorly. Coil embolization of CHA was done and the patient improved.

Clinical Discussion: Pseudoaneurysm of the common hepatic artery is a serious complication after abdominal surgery. Only a few cases have been reported with similar symptoms related to gastrointestinal bleeding following various upper abdominal surgeries. Coil embolization is a gold standard technique with a high success rate.

Conclusion: CHA pseudoaneurysm is a dreadful potential complication of abdominal surgery including gastrectomy. Early recognition and emergency management of CHA pseudoaneurysm are crucial for a favorable outcome for patients with bleeding from CHA aneurysm.
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http://dx.doi.org/10.1016/j.ijscr.2021.105816DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8027270PMC
April 2021

Prevalence of vancomycin-resistant enterococci in Asia-A systematic review and meta-analysis.

J Clin Pharm Ther 2021 Feb 25. Epub 2021 Feb 25.

Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.

What Is Known And Objective: The rise of vancomycin-resistant enterococci (VRE) has been a major health problem in most countries of the world including Asia, since its discovery. There is a paucity of data on VRE in many countries of Asia as well as limited pooled estimates. Therefore, we performed a systematic review and meta-analysis to estimate a pooled prevalence of VRE in Asia.

Methods: A literature search in electronic databases like PubMed, Embase and Google Scholar and manual searching of references and grey literature, comprising the information on the prevalence of VRE with at least two species of enterococci, conducted in different countries of Asia from January 1, 2000, to September 20, 2020, was done. The random-effect model and 95% CIs was used to calculate the pooled prevalence. Subgroup, sensitivity and meta-regression analyses were performed to address heterogeneity while Egger's test for publication bias.

Results And Discussions: We identified 39 studies, comprising a total of 11,875 enterococcal isolates. The result of the analysis showed that the pooled prevalence of VRE in Asia was 8.10% (95% CI; 7-9; I  = 93.79%; p < 0.001). Resistance to vancomycin was greater among strains of E. faecium compared to the strains of E. faecalis (22.40% vs. 3.70%). Amongst various regions of Asia, the highest prevalence of VRE was found in the Western Asian region and the lowest in the South-east Asian region. Moreover, the rate of VRE was higher than most European countries and lower than USA.

What Is New And Conclusions: With an upsurge of VRE in Asia in recent years, efficient infection control programmes, robust surveillance systems and adherence to antibiotic stewardship are paramount to halt the further rise of VRE.
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http://dx.doi.org/10.1111/jcpt.13383DOI Listing
February 2021

Impalement injury of the perineum with an iron rod with a minimal injury: A near miss: A case report.

Int J Surg Case Rep 2021 Mar 11;80:105645. Epub 2021 Feb 11.

Department of Pediatric Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Electronic address:

Introduction And Importance: Penetrating perineal injury in children is uncommon. However, the injury is serious and life-threatening with significant morbidity and mortality.

Case Presentation: We report an unusual case of a 13-year-old boy with an accidental perineal impalement injury by an iron rod, which pierced through the perineum and exited through the left loin, however with minimal external and internal injuries.

Clinical Discussion: Multiple vital organs in the pelvic space are vulnerable to damage in perineal impalement injury. Vital organ injury, amount of blood loss, and effectiveness of the resuscitation determine the outcome of an impalement injury. Urgent laparotomy forms the cornerstone in management as all the potential injuries can be identified and managed immediately.

Conclusion: Effective resuscitation and accurate assessment of the associated injuries along with proper pre-hospital care with a multidisciplinary approach is crucial for the survival and optimum outcome of the victim.
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http://dx.doi.org/10.1016/j.ijscr.2021.105645DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7900347PMC
March 2021

Portal hypertension: An uncommon presentation of Caroli's syndrome.

Clin Case Rep 2020 Dec 24;8(12):3134-3138. Epub 2020 Sep 24.

Department of Gastrointestinal Surgery Tribhuvan University Teaching Hospital Kathmandu Nepal.

Portal hypertension is not a classical presentation of Caroli's syndrome. However, some young children can present with overt signs and symptoms indicative of advanced disease state despite the improvement in imaging technology which has decreased its diagnostic age. High index of clinical suspicion can help in timely diagnosis and management.
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http://dx.doi.org/10.1002/ccr3.3374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752578PMC
December 2020

Giant cell glioblastoma in 6-year-old kid: Report of an unusual case.

Clin Case Rep 2020 Dec 14;8(12):2936-2940. Epub 2020 Sep 14.

Department of Pathology Tribhuwan University Teaching Hospital Kathmandu Nepal.

Pediatric giant cell glioblastoma, a highly malignant and lethal tumor, can only be distinguished from glioblastoma multiforme histologically. Though it is said to have a better prognosis, adequate evidence in favor is lacking. Early diagnosis with gross total resection and adjuvant chemotherapy might increase the survival period.
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http://dx.doi.org/10.1002/ccr3.3102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752560PMC
December 2020

healthy South Asians.

JGH Open 2020 Dec 12;4(6):1037-1046. Epub 2020 Oct 12.

Maharajgunj Medical Campus Tribhuvan University Institute of Medicine Kathmandu Nepal.

We aimed to estimate the pooled prevalence of among asymptomatic South Asians based on available literature and highlight the importance of screening asymptomatic individuals and implementing preventive strategies for eradicating . Electronic databases such as PubMed and Embase, a regional database of WHO South Asian Region, and gray literature sites were searched for relevant studies from 1983 to 5 May 2020. In addition, references of the included studies were thoroughly searched. The random-effect model was used to calculate the pooled prevalence with a 95% confidence interval (CI) along with subgroup analysis. Analysis of 19 studies showed a pooled prevalence of 56.5%, ranging from 10.3 to 91.7%. In subgroup analysis by country, the highest prevalence rate was reported from Bangladesh (86.3%, 95% CI: 0.806-0.921), whereas the lowest prevalence was from Sri Lanka (10.3%, 95% CI: 0.072-0.135). No differences were found between males and females. Prevalence among children and adolescents was 65.3% (95% CI: 0.529-0.777), greater than adults, 56.9% (95% CI: 0.353-0.785). The prevalence rate showed a decreasing trend upon comparison of studies conducted before and after 2000. Our analysis reveals the high prevalence of infection among asymptomatic healthy populations in South Asia, particularly in children and adolescents. Public health awareness and sanitation interventions, pure drinking water, and respective strategies on a policy level to eradicate and additional extensive multicentric cohort studies are necessary.
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http://dx.doi.org/10.1002/jgh3.12426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731813PMC
December 2020

Surgical Delay due to Ethylenediaminetetraacetic Acid-Induced Pseudothrombocytopenia.

Cureus 2020 Jul 19;12(7):e9273. Epub 2020 Jul 19.

Surgery, Tribhuvan University, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, NPL.

Automated hematology analyzer uses the Coulter principle leading to different cell types based on their size. Despite being rapid and convenient, it can result in spurious outcomes like ethylenediaminetetraacetic acid (EDTA)-induced pseudothrombocytopenia. EDTA-induced pseudothrombocytopenia is an immunologically mediated phenomenon resulting from a change in the configuration of glycoprotein (GP) IIb/IIIa by EDTA. The consequence is an exposure of hidden epitope that reacts with certain autoantibodies resulting in spuriously low platelet counts when the blood samples are evaluated by automated blood analyzers. Although it is a rare cause of thrombocytopenia, if not recognized, it can result in unnecessary investigations and treatments. In this case, EDTA-induced psuedothrombocytopenia delayed laparoscopic cholecystectomy planned for symptomatic cholelithiasis in a 58-year-old male. The presence of large platelet clumps on peripheral smear and normal manual platelet counts confirmed the diagnosis. Pseudothrombocytopenia should be suspected when there is no correlation between clinical and laboratory findings in a patient with a low platelet count. Reperforming counts with other anticoagulants and if necessary, manual count in the peripheral blood smear is suggested.
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http://dx.doi.org/10.7759/cureus.9273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431305PMC
July 2020

Bilateral ovarian edema with unilateral ovarian leiomyoma and double inferior vena cava: a case report.

J Med Case Rep 2020 Jul 12;14(1):97. Epub 2020 Jul 12.

Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.

Background: Ovarian edema, ovarian leiomyoma, and double inferior vena cava are all rare clinical entities. The coexistence of all these entities has not been yet reported in the literature.

Case Presentation: We report a case of a 25-year-old nulliparous tamang woman with all these rare clinical entities, who presented with a complaint of right-sided lower abdominal pain. After examination and investigation, an ovarian tumor was suspected and laparotomy was performed during which bilateral ovarian edema with a solid tumor on the left side was identified and left salpingo-oophorectomy was done preserving her right ovary. A histopathological examination confirmed the clinical findings.

Conclusions: As ovarian edema is a rare entity, due to lack of clinical suspicion it is often overdiagnosed as a malignant tumor leading to radical surgery with subsequent loss of hormonal function and early infertility. A high degree of clinical suspicion during the intraoperative period is helpful for diagnosis to avoid unnecessary oophorectomy and infertility.
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http://dx.doi.org/10.1186/s13256-020-02418-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354687PMC
July 2020

Correction to: Atrial myxoma with cerebellar signs: a case report.

J Med Case Rep 2020 03 17;14(1):42. Epub 2020 Mar 17.

Maharajgunj Medical Campus, Maharajgunj, Kathmandu, Nepal.

In the publication of this article [1], there is an error in the name of one of the contributing authors.
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http://dx.doi.org/10.1186/s13256-020-02364-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7079512PMC
March 2020

Atrial myxoma with cerebellar signs: a case report.

J Med Case Rep 2020 Feb 13;14(1):29. Epub 2020 Feb 13.

Maharajgunj Medical Campus, Maharajgunj, Kathmandu, Nepal.

Background: Atrial myxoma remains a rare clinical entity with an incidence of surgically resected cases of 0.5-0.7 per million population and prevalence of < 5 per 10,000. It typically manifests in woman after third decade of life; symptoms vary greatly and may present with arrhythmia, intracardiac flow obstruction, embolic phenomenon, and associated constitutional symptoms. Neurological complications associated with atrial myxoma most frequently include cerebral infarct due to embolus. Cerebellar involvement is very rare and only a few cases have been reported in the literature.

Case Presentation: A 55-year-old Brahmin man with no history of diabetes mellitus and hypertension, presented with complaints of dizziness, headache, vomiting, double vision, and unsteadiness of gait for 2 weeks. His headache was sudden in onset, of a pulsating type and localized on left temporal side. Vomiting was projectile and bilious. Double vision was present in all directions of gaze and he had uncoordinated movement of his body and tilting to the left side. On examination, his cerebellar functions were impaired. He was thoroughly investigated for the cause of stroke after abnormal magnetic resonance imaging results with normal computed tomography angiography of his brain. Echocardiography and computed tomography of his chest showed a mass attached to intra-atrial septum and prolapsing through mitral valve, which was suggestive of left atrial myxoma. Five days following admission, he developed abdominal pain due to thromboembolism causing splenic and renal infarct.

Conclusion: Although rare, atrial myxoma has to be considered a cause of stroke and other embolic phenomenon causing multiorgan infarctions. Early and timely diagnosis of the condition can prevent further recurrence and inappropriate anticoagulant therapy. It would be pertinent to have echocardiography done in patients who present with a stroke, arrhythmias, and other constitutional symptoms. The tumor once detected must be removed surgically as early as possible, which not only reduces serious thromboembolic complications but can be potentially curative.
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http://dx.doi.org/10.1186/s13256-020-2356-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017557PMC
February 2020

Calvarial Tuberculosis: A Diagnostic Quandary: A Case Report.

JNMA J Nepal Med Assoc 2019 May-Jun;57(217):198-201

Department of Neurosurgery, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.

Primary Calvarial Tuberculosis, a rare entity of skull is even rarer after second decade of life in a healthy person without evidence of tuberculosis elsewhere in the body. Most of the cases are often misdiagnosed as osteomyelitis/syphilis/bony metastasis. We report a case of primary skull tuberculosis in 26-year-old male with complains of headache and swelling in the right frontal region with no history of previous tuberculosis. The patient was operated and the histopathological examination of excised tissue was suggestive of tubercular pathology. The patient is doing well after anti-tubercular therapy. Being a rare disease, tubercular osteomyelitis of skull bones is often missed and misdiagnosed due to lack of clinical suspicion and slow growth of mycobacterium cultures. Histopathological examination of biopsy material and demonstration of acid-fast bacilli in the pus are helpful for diagnosis and early management of the disease. Keywords: calvaria; Mycobacterium; osteomyelitis; tuberculosis.
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February 2020

Package of essential noncommunicable disease (PEN) interventions in primary health-care settings in the Democratic People's Republic of Korea: A feasibility study.

WHO South East Asia J Public Health 2017 09;6(2):69-73

School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

The prevention and control of noncommunicable diseases (NCDs) is a priority for the Democratic People's Republic of Korea. Mortality due to NCDs in people aged over 30 years was 1239 per 100 000 in 2009 and the 2014-2020 national strategy includes population-level goals for health promotion and disease prevention. This paper reports a pilot study on the feasibility of implementing components of the World Health Organization (WHO) Package of essential noncommunicable disease (PEN) interventions for primary health care in low-resource settings (WHO PEN) to enable early detection and management of cardiovascular disease and diabetes mellitus at the level of primary care. WHO PEN protocols were adapted for local use by household doctors, who provide ambulatory care in polyclinics in the mornings and household visits in the afternoons. The pilot project was implemented in two polyclinics in Pyongyang, covering a population of 32 000. After training, and during routine household visits in June 2014, 70 household doctors screened all adults aged over 35 years (18 340) for cardiovascular disease and diabetes mellitus, and their risk factors. A total of 2319 patients with cardiovascular disease or diabetes, and those with high-risk factors, were referred to the polyclinics for three quarterly visits for testing and management. Final household screening of the population was done in June 2015. This pilot project demonstrated the feasibility of integrating screening and management into the standard primary health-care system in the Democratic People's Republic of Korea. The household doctors were able to detect and manage risks for cardiovascular disease and diabetes by using the protocols based on WHO PEN. Among 18 340 individuals aged over 35 years, implementation of WHO PEN interventions led to a significant reduction in the number of people with a 10-year risk of cardiovascular disease ≥20% (from 1748 [9.5%] to 543 [3.0%]) over a 1-year period. Involvement of household doctors can increase access to services for prevention and control of cardiovascular disease and diabetes in the Democratic People's Republic of Korea.
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http://dx.doi.org/10.4103/2224-3151.213794DOI Listing
September 2017

Procyanidin B2 3,3(″)-di-O-gallate, a biologically active constituent of grape seed extract, induces apoptosis in human prostate cancer cells via targeting NF-κB, Stat3, and AP1 transcription factors.

Nutr Cancer 2014 5;66(4):736-46. Epub 2013 Nov 5.

a Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences , University of Colorado Anschutz Medical Campus , Aurora , , Colorado , USA.

Recently, we identified procyanidin B2 3,3(″)-di-O-gallate (B2G2) as most active constituent of grape seed extract (GSE) for efficacy against prostate cancer (PCa). Isolating large quantities of B2G2 from total GSE is labor intensive and expensive, thereby limiting both efficacy and mechanistic studies with this novel anticancer agent. Accordingly, here we synthesized gram-scale quantities of B2G2, compared it with B2G2 isolated from GSE for possible equivalent biological activity and conducted mechanistic studies. Both B2G2 preparations inhibited cell growth, decreased clonogenicity, and induced cell cycle arrest and apoptotic death, comparable to each other, in various human PCa cell lines. Mechanistic studies focusing on transcription factors involved in apoptotic and survival pathways revealed that B2G2 significantly inhibits NF-κB and activator protein1 (AP1) transcriptional activity and nuclear translocation of signal transducer and activator of transcription3 (Stat3) in PCa cell lines, irrespective of their functional androgen receptor status. B2G2 also decreased survivin expression which is regulated by NF-κB, AP1, and Stat3 and increased cleaved PARP level. In summary, we report B2G2 chemical synthesis at gram-quantity with equivalent biological efficacy against human PCa cell lines and same molecular targeting profiles at key transcription factors level. The synthetic B2G2 will stimulate more research on prostate and possibly other malignancies in preclinical models and clinical translation.
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http://dx.doi.org/10.1080/01635581.2013.783602DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4079462PMC
December 2014

Influence of traffic activity on heavy metal concentrations of roadside farmland soil in mountainous areas.

Int J Environ Res Public Health 2012 05 7;9(5):1715-31. Epub 2012 May 7.

Key Laboratory of Tibetan Environment Changes and Land Surface Processes, Institute of Tibetan Plateau, Chinese Academy of Sciences, Beijing 100080, China.

Emission of heavy metals from traffic activities is an important pollution source to roadside farmland ecosystems. However, little previous research has been conducted to investigate heavy metal concentrations of roadside farmland soil in mountainous areas. Owing to more complex roadside environments and more intense driving conditions on mountainous highways, heavy metal accumulation and distribution patterns in farmland soil due to traffic activity could be different from those on plain highways. In this study, design factors including altitude, roadside distance, terrain, and tree protection were considered to analyze their influences on Cu, Zn, Cd, and Pb concentrations in farmland soils along a mountain highway around Kathmandu, Nepal. On average, the concentrations of Cu, Zn, Cd, and Pb at the sampling sites are lower than the tolerable levels. Correspondingly, pollution index analysis does not show serious roadside pollution owing to traffic emissions either. However, some maximum Zn, Cd, and Pb concentrations are close to or higher than the tolerable level, indicating that although average accumulations of heavy metals pose no hazard in the region, some spots with peak concentrations may be severely polluted. The correlation analysis indicates that either Cu or Cd content is found to be significantly correlated with Zn and Pb content while there is no significant correlation between Cu and Cd. The pattern can be reasonably explained by the vehicular heavy metal emission mechanisms, which proves the heavy metals' homology of the traffic pollution source. Furthermore, the independent factors show complex interaction effects on heavy metal concentrations in the mountainous roadside soil, which indicate quite a different distribution pattern from previous studies focusing on urban roadside environments. It is found that the Pb concentration in the downgrade roadside soil is significantly lower than that in the upgrade soil while the Zn concentration in the downgrade roadside soil is marginally higher than in the upgrade soil; and the concentrations of Cu and Pb in the roadside soils with tree protection are significantly lower than those without tree protection. However, the attenuation pattern of heavy metal concentrations as a function of roadside distance within a 100 m range cannot be identified consistently.
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http://dx.doi.org/10.3390/ijerph9051715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3386583PMC
May 2012

Glucuronidation and methylation of procyanidin dimers b2 and 3,3″-di-o-galloyl-b2 and corresponding monomers epicatechin and 3-o-galloyl-epicatechin in mouse liver.

Pharm Res 2012 Mar 9;29(3):856-65. Epub 2011 Nov 9.

Department of Pharmaceutical Sciences, School of Pharmacy, University of Colorado Denver, Anschutz Medical Campus, MS C238, 12850 E. Montview Blvd., Aurora, Colorado, 80045, USA.

Purpose: The 3,3″-di-O-galloyl ester of procyanidin B2 (B2G2) is a component of grape seed extract that inhibits growth of human prostate carcinoma cell lines. In preparation for studies in mice, its hepatic metabolism was examined in vitro and compared to B2 and the corresponding monomers, epicatechin (EC) and 3-O-galloyl-epicatechin (ECG).

Methods: Compounds were incubated with liver microsomes or cytosol containing cofactors for glucuronidation, sulfation or methylation, and products analyzed by liquid chromatography-mass spectrometry (LC-MS). B2G2 was administered orally to mice and plasma analyzed by LC-MS for unmodified procyanidin and metabolites.

Results: Glucuronides and methyl ethers of B2 and B2G2 were formed in small amounts. In contrast, EC and ECG were largely or completely converted to glucuronides, sulfates and methyl ethers under the same incubation conditions. B2G2 given orally to mice was partially absorbed intact; no significant metabolites were detected in plasma.

Conclusions: Glucuronidation and methylation of procyanidins B2 and B2G2 occurred but were minor processes in vitro. B2G2 was partially absorbed intact in mice after oral dosing and did not undergo significant metabolism. Unlike the flavanol monomers EC and ECG, therefore, B2G2 bioavailability should not be limited by metabolism. These results paved the way for ongoing pharmacokinetic and efficacy studies.
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http://dx.doi.org/10.1007/s11095-011-0614-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3288310PMC
March 2012

Nitric oxide production inhibitory activity of flavonoids contained in trunk exudates of Dalbergia sissoo.

J Nat Prod 2008 Jan 22;71(1):98-101. Epub 2007 Dec 22.

Kyoritsu University of Pharmacy, Tokyo, Japan.

Methanolic extracts of trunk exudates of Dalbergia sissoo yielded two new open-chain neoflavonoids (1, 2), a new flavonoid (3), a new flavanone (4), and 26 known compounds. Their structures were elucidated by detailed spectroscopic analyses. The ability of the isolated compounds to prevent nitric oxide (NO) production by LPS-stimulated J774.1 cells was also studied. All of the isolated compounds except 4, formononetin, and zenognosin B exhibited significant activity in a concentration-dependent manner. Compounds 2 and 3 were among the most potent NO production inhibitors, with IC50 values of 3.19 and 6.22 microM, respectively, and compound 1 had an IC50 of 31.6 microM.
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http://dx.doi.org/10.1021/np070478hDOI Listing
January 2008

Synthesis and biological activities of glycosphingolipid analogues from marine sponge Aplysinella rhax.

Bioorg Med Chem Lett 2007 Nov 29;17(21):5912-5. Epub 2007 Aug 29.

Kyoritsu University of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan.

A novel glycosphingolipid, beta-D-GalNAcp(1-->4)[alpha-D- Fucp(1-->3)]-beta-D-GlcNAcp(1-->)Cer (1), isolated from the marine sponge Aplysinella rhax, has a unique structure, with D-fucose and N-acetyl-D-galactosamine attached to a reducing-end N-acetyl-D-glucosamine through an alpha1-->3 and beta1-->4 linkage, respectively. We synthesized glycolipid analogues carrying a 2-branched fatty alkyl residue or a 2-trimethylsilyl ethyl residue in place of ceramide (2 and 3), non-natural type trisaccharide analogue containing an L-fucose residue (4), and other analogues (5 and 6). Among these prepared compounds, 2 showed the most potent nitric oxide (NO) production inhibitory activity against LPS-activated J774.1 cells. In addition, their structure-activity relationships were established.
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http://dx.doi.org/10.1016/j.bmcl.2007.07.108DOI Listing
November 2007

Chemical constituents of Nepalese propolis (II).

Chem Pharm Bull (Tokyo) 2007 Jun;55(6):926-9

Kyoritsu University of Pharmacy, Minato-ku, Tokyo, Japan.

A novel flavanonol (1), three new isoflavones (2-4) and a new flavan-3-ol (5) were isolated along with ten other known flavonoids (6-15) from the methanolic extract of propolis collected from Chitwan, Nepal. Their structures were determined on the basis of spectral analysis.
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http://dx.doi.org/10.1248/cpb.55.926DOI Listing
June 2007

Neoflavonoids and related constituents from Nepalese propolis and their nitric oxide production inhibitory activity.

J Nat Prod 2005 Jun;68(6):858-64

Institute of Natural Medicine, Toyama Medical and Pharmaceutical University, Japan.

A methanolic extract of Nepalese propolis yielded 10 new open-chain neoflavonoids (1-10), a new chalcone (11), and eight previously reported compounds (12-19). Their structures were determined on the basis of spectroscopic data and chemical conversion. The isolated compounds other than 5, 8, and 16 showed dose-dependent inhibitory activities on nitric oxide production in lipopolysaccharide-activated macrophage-like J774.1 cells and were more active than a positive control, N(G)-monomethyl-L-arginine (IC(50), 27.1 microM). The most potent activities, of 6 and 7 (IC(50), 0.5 microM), were greater than another positive control, caffeic acid phenethyl ester (IC(50), 4.8 microM).
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http://dx.doi.org/10.1021/np050009kDOI Listing
June 2005
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