Naba Raj Mainali

Thomas Jefferson University Hospitals | TJUH · Division of Cardiology

Listeria is an uncommon cause of spontaneous bacterial peritonitis (SBP) in the United States. Listeria should be suspected as a cause of SBP when the patient has diphtheria-like organisms on ascitic/blood cultures, iron overload/hemochromatosis, exposure to farm animals, or poor response to empiric therapy within 48-72 h. Diagnosis of SBP is made...

Objective: Conduct a systematic review and meta-analysis on the effectiveness and safety of varenicline in smokeless tobacco cessation. Methods: PubMed, EMBASE, clinicaltrials.gov and the Cochrane Registry were searched up to February 1, 2014 for randomized clinical trials (RCTs) comparing varenicline to placebo. Random effects Mantel-Haenszel su...

Retroperitoneal extramedullary plasmacytoma (EMP) is a rare condition that often poses a diagnostic challenge. This is mainly due to its unusual location and non-specific symptoms especially in its early stages. Retroperitoneal plasmacytoma with renal involvement is an extremely rare entity and to date, less than 25 cases have been reported in the...

Background Although dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is a widely accepted strategy in patients undergoing TAVR, this approach is not evidence based. We therefore sought to systematically review the current evidence for this practice in terms of 30-day outcome looking at stroke, MI, bleeding, and death. Methods Relevant...

Patient: Male, 67 Final Diagnosis: Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome Symptoms: Bilateral wrist swelling Medication: - Clinical Procedure: - Specialty: Rheumatology. Unusual or unexpected effect of treatment. Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is a rare clin...

Aim The benefit of preventive percutaneous coronary intervention (PCI) in ST elevation myocardial infarction (STEMI) has been shown in randomised trials. However, all the randomised trials are underpowered to detect benefit in cardiac death. We aim to systematically review evidence on the cardiac mortality benefit of preventive PCI in patients pres...

Diarrhea caused by Cryptosporidium is most commonly seen in patients with HIV or AIDS or other immunocompromised conditions like diabetes mellitus, or patients on a high dose of steroids or immunosuppressants. The organism is a parasite that infects gastrointestinal epithelium, producing potential life-threatening diarrhea in people with AIDS but u...

A previously healthy 17-year-old female presented with fever, sore throat and lympadenopathy. Initial management was directed at treating infectious mononucleosis, however, her condition did not improve. A CT scan of the chest indicated multifocal pneumonia. A subsequent CT scan of the neck revealed internal jugular vein thrombosis. A diagnosis of...

Patient: Female, 91 Final Diagnosis: Low-grade gastric MALT lymphoma Symptoms: Recurrent epigastric and right upper quadrant dyscomfort Medication: Rituximab Clinical Procedure: esophagogastroduodenoscopy • gastric biopsy Specialty: Gastroenterology. Unusual or unexpected effect of treatment. Mucosa associated lymphoid tissue (MALT) lymphoma can oc...

Interferon has been widely used in the management of patients with hematological malignancies such as polycythemia vera, myelofibrosis, chronic myeloid leukemia and viral infections such as chronic hepatitis C. Hematological adverse effects such as cytopenias have been observed, particularly in patients who receive a combination of interferon-α-2a...

Recurrent Takotsubo cardiomyopathy is a relatively uncommon condition seen in patients with severe physical or emotional stress. We report a case of a 51-year-old woman who had recurrent Takotsubo cardiomyopathy with involvement of apical left ventricular (LV) segments, induced by intense emotional stress. On two occasions she presented with sympto...

Although rarely reported in the literature, adenomatous polyp and adenocarcinoma can occur as a late complication in an interposed colonic segment. We describe a case of a late stage adenocarcinoma in a colonic interposition performed for benign oesophageal stricture.

Introduction A laugh-induced seizure is an unrecognized condition and to the best of our knowledge no case has been reported in the medical literature until now. We present an interesting and extremely rare case in which laughing generated the seizure activity that was recorded and confirmed by video electroencephalography. Case presentation A 43-...

Although relatively uncommon, the incidence of non-steroidal anti-inflammatory drug-induced aseptic meningitis appears to be increasing among patients with connective tissue disease and also among the healthy population. Ibuprofen is the most common culprit identified. We report a case of a 28-year-old woman with mixed connective tissue disease and...

Papillary fibroelastoma of the aortic valve is an uncommon benign tumor of the heart that can present with embolic events. We report a case of 54-year-old lady with exertional chest pain and prior history of ST segment elevation myocardial infarction who was subsequently found to have a fibroelastoma of the aortic valve. The absence of angiographic...

Hypertriglyceridaemia is the third most common cause of acute pancreatitis in the USA. The treatment approach for hypertriglyceridaemia to date has largely been conservative including weight loss, exercise and avoidance of medications that raise triglyceride levels. This approach, however, is not practical in cases of acute pancreatitis due to seve...

Hashimoto’s encephalopathy (HE) is a rare form of reversible encephalopathy characterized by the presence of anti-thyroid antibodies in serum and/or cerebrospinal fluid. The syndrome is more common in women and the presentation varies considerably. Here, we report a case of an elderly male with a history of Hashimoto’s thyroiditis, presenting with...

Thrombotic thrombocytopenic purpura (TTP) is uncommon in the postoperative setting, even more so after vascular surgery. We present a case of thrombocytopenia after aortofemoral bypass, which highlights the importance of a high index of suspicion for postoperative TTP to avoid life-threatening consequences.

Introduction: Since the Emergency Department (ED) of TUTH lacks uniformity in the treatment of stroke patients, it is assumed that these patients do not receive standard treatment in terms of reduction of blood pressure (BP), control of hyperglycemia and treatment with antithrombotic agents. Our hospital-based study aims to assess the mean stay of...

Background: Modifiable risk factors of stroke are presumably poorly controlled in Nepalese population. This hospital-based study aims to assess the prevalence and control of these risk factors in stroke patients admitted to Tribhuvan University Teaching Hospital prior to the occurrence of stroke. Method: The study was conducted among sixty-one pati...