Adherence to antihypertensive medication and its associated factors among patients with hypertension attending a tertiary hospital in Kathmandu, Nepal.

Hypertension is a major risk factor for cardiovascular disease, which is the leading cause of premature mortality and morbidity globally. Despite the evidences of the availability of effective treatment for hypertension, its management remains suboptimal. Medication adherence is the most crucial factor for blood pressure control. It is important to identify the factors associated with adherence to antihypertensive treatment for better management. Hence, this study assessed the level of antihypertensive medication adherence and its associated factors among patients with hypertension visiting a tertiary-level hospital in Kathmandu, Nepal. An analytical cross-sectional study was carried out among 308 diagnosed patients with hypertension who were prescribed antihypertensive medication. The Morisky Medication Adherence Scale (MMAS-8) was used to assess medication adherence. Data was collected through face-to-face interviews and analysed using SPSS v26. A bivariate and multivariate logistic regression model was used to assess the factors associated with low medication adherence. More than half (61%) of the study participants had moderate to high levels of medication adherence. Upon bivariate analysis, there was a significant association between presence of side effects, blood pressure status, forgetfulness, high cost, fear of taking medicine lifelong and irregular follow-up with a low level of adherence. Upon multivariate the logistic regression analysis, forgetfulness [Adjusted Odd's Ratio (AOR) 22.5, 95% Confidence Interval(CI) 10.56-47.86], high cost (AOR 3.8, 95%CI 1.25-11.60) and fear of taking medicines lifelong (AOR 6.04, 95%CI 2.96-12.33) were found to be associated factors of low level of adherence. There is an urgency to develop evidence-based strategies to improve the level of adherence to antihypertensive medications among patients with hypertension. Strategies like reminder messaging, setting alarms, expanding the scope of national health insurance and proper counselling to reduce fear could help to improve medication adherence. Hence, the feasibility and effectiveness of such intervention should be explored in future studies.

Takayasu arteritis in a young male patient: a case report and review of literature.

Takayasu arteritis is a systemic inflammatory disorder that causes harm to the large and medium arteries and their branches. It is primarily prevalent in Asia, Africa, and Latin America, with the incidence rate in Asia being reported to be 100 times higher than in Europe and North America. Females in their second or third decades of life are most commonly affected by this condition. In our case, a 26-year-old male patient was diagnosed with Takayasu arteritis after he experienced a headache and left upper limb weakness. The initial presentation of Takayasu arteritis includes nonspecific constitutional symptoms like fever, malaise, weight loss, and anorexia. Unfortunately, due to the delayed diagnosis of the disease, patients often experience claudication, absence of pulses, hypertension, myocardial infarction, and cerebrovascular accidents. An early and accurate diagnosis of Takayasu arteritis is vital to reduce the economic, social, and psychological burdens associated with the disease.

SARS-COV-2-related superior mesenteric artery thrombosis resulting in pneumatosis intestinalis complicated by pneumatosis portalis in a young male: a case report.

The novel coronavirus disease-2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 is a highly contagious disease that has rapidly spread throughout the world. In addition to respiratory complications, the virus has also been linked to damage other organ systems as well as coagulopathy. The features and clinical spectrum of COVID-19 are continually emerging, with growing evidence of its connection to thrombosis in various systems. In this case report, the authors present a case of COVID-19 infection in a young male patient who had superior mesenteric artery thrombosis with pneumatosis intestinalis complicated by hepatic portal venous gas.

Late diagnosis of tuberous sclerosis complex in a 40-year-old female presenting with abdominal pain: a case report.

Tuberous sclerosis (TS) is a rare autosomal-dominant neurocutaneous disorder that is characterized by hamartomas affecting a variety of organs, including the brain, heart, kidneys, skin, lungs, and liver. TS can emerge in a wide variety of clinical and phenotypic forms at any age, all with varying degrees of severity, and is brought on by mutations in the tumor suppressor genes TSC1 or TSC2. This case report is about a 40-year-old female with facial angiofibromas and abdominal symptoms who was referred to the radiology department of our hospital for ultrasonography of the abdomen, which revealed echogenic mass lesions/angiomyolipomas in bilateral kidneys. Subsequent contrast-enhanced computed tomography of the abdomen revealed large fat-attenuating mass lesions which were confirmed to be angiomyolipomas. Similarly, noncontrast computed tomography of the head showed multiple calcified nodules/tubers in subependymal, subcortical, and cortical locations of the brain. High-resolution computed tomography of the chest showed multiple cystic lesions in bilateral lungs suggestive of lymphangioleiomyomatosis. The aim of this case report is to highlight the late presentation of tuberous sclerosis complex.

Hepatic portal venous gas in the case of superior mesenteric artery thrombosis in a young adult-case report.

Hepatic portal venous gas is diagnosed via computed tomography due to unusual imaging features. HPVG when linked with pneumatosis intestinalis has a high mortality rate and required urgent intervention. We present a case of a 26-year-old young adult with superior mesenteric artery thrombosis who presented with severe abdominal pain. On imaging, HPVG and pneumatosis intestinalis were seen owing to the urgent intervention of the patient. The reliable interpretation of the imaging findings along with quick intervention led to a favorable outcome in our case. Herein, we present a thorough review of the imaging findings of HPVG to make a reliable diagnosis when presented with such a case.

Non-traumatic splenic rupture and pancreatic pseudocyst as a complication of pancreatitis: A case report.

Nontraumatic splenic rupture is a rare pancreatitis complication. We present a 61-year-old chronic alcoholic male with acute on chronic pancreatitis, which progressed to pseudocyst, splenic vein thrombosis, splenic rupture, and eventually hemoperitoneum. Later, the patient required an emergency laparotomy and splenectomy. Early detection and treatment of pancreatitis and pseudocyst can help prevent a rare but potentially fatal complication like an acute rupture.

A rare case of thoracic lipomyelomeningocele in a young female: A case report.

Thoracic lipomyelomeningocele is a rare type of congenital occult spinal dysraphism. It is characterized by lipomatous tissue connected to the dorsal spinal cord that protrudes through a spinal defect together with the meninges or spinal cord to form a posterior mass beneath the skin. Closed spinal dysraphism can present diagnostic challenges when resources are scarce and advanced imaging techniques like magnetic resonance imaging are not readily available. Here, we describe a case of thoracic lipomyelomeningocele, a type of closed spinal dysraphism in a young female presenting with gradually progressive weakness and tingling sensation in bilateral lower limbs over the last 6 months. On physical examination, she had a soft tissue swelling with dimpling over the dorsal spine and paraparesis. Magnetic resonance imaging of the spine revealed dorsal lipomyelomeningocele corresponding to D4-D7 vertebral levels with tethered spinal cord.

Shepherd's crook configuration of right coronary artery and anomalous origin of left circumflex artery from right coronary cusp in a middle-aged man-A case report.

Shepherd's crook configuration of the right coronary artery is a course anomaly where the ostium is oriented superiorly with the proximal artery taking an upward turn before resuming its regular path. Although it is classified as an unimportant hemodynamic variation, it is relevant in the context of coronary artery disease due to the technical issues it causes when being treated. The anomalous origin of the left circumflex artery arising as a separate branch from the right coronary cusp is a rare variant and its significance lies in its association with sudden arrhythmia, syncope, and sudden cardiac death. Here we report a case of a 58-year-old male patient with an anomalous course of the right coronary artery consistent with Shepherd's crook configuration and anomalous origin of the left circumflex artery from the right coronary cusp.

Multiple intracranial hydatid cysts in posterior fossa in an adult-A case report.

Hydatid cyst is an uncommon parasitic disease caused by larval stages of Echinococcus granulosus. The liver is the most frequently affected organ followed by the lungs and the spleen. Intracranial hydatid cysts are uncommon and occur mostly in supratentorial region. It can present with nonspecific symptoms and can be difficult to diagnose, thus regardless of unusual clinical presentation and unusual location of cystic lesion in brain, it is crucial to keep hydatid cyst as one of the differentials. We describe a case of a 28-year-old male who presented with headache, vomiting and cerebellar signs. MRI showed multiple cystic lesions in posterior fossa with asymmetrically dilated posterior horn of left lateral ventricle. Biopsy from one of the cystic lesions from posterior fossa was performed which confirmed the diagnosis of hydatid cyst. Patient was started on Albendazole and subsequently planned for surgery.

Role of MRI in X-linked adrenoleukodystrophy-A case report.

X-linked adrenoleukodystrophy is a rare inherited peroxisomal disorder that occurs due to a genetic mutation. This mutation impairs normal transport of very long-chain fatty acids (VLCFAs) into peroxisomes, hence impeding VLCFA breakdown leading to its accumulation in plasma and tissues of the body. Due to its X-linked inheritance, it classically affects young males with most cases diagnosed during childhood. There are characteristic MRI findings in brain which can aid in diagnosis of X-ALD. We hereby present a case of a 10-year-old boy who presented with neurological and behavioral deterioration with MRI findings suggestive of X-ALD. MRI not only aids in diagnosis of X-ALD but can also identify the pattern of brain involvement which serves an important role in prognosis and outcome of the disease.

Late diagnosis of dorsolumbar lipomyelomeningocele with tethered cord in a middle aged adult: A case report from Nepal.

Closed spinal dysraphism can present with diagnostic issues in settings with limited resources, when knowledge of the disorder and specialized radiological studies, such as magnetic resonance imaging (MRI), may not be readily available. Undiagnosed cases can develop serious neurological deficits. Here, we describe a case of dorsolumbar lipomyelomeningocele, a type of closed spinal dysraphism, presenting in a middle aged with paraplegia complicated by bed sores. A 38-year-old female with no significant past medical history experienced gradually progressive weakness of bilateral lower limbs over 9 years. On physical examination, patient had a soft swelling with hairy tuft over the lumbar spine, paraplegia, grade III bed sore over the gluteal region, and sensory loss below L1 sensory level. Her bowel and bladder sensation were decreased. The soft tissue swelling over her back was not evaluated appropriately before this presentation. MRI of the spine revealed dorsolumbar lipomyelomeningocele with tethered spinal cord.

Dyke-Davidoff-Masson syndrome: A rare case of hemiatrophy of brain-Case report from Nepal.

Dyke-Davidoff-Masson syndrome (DDMS) is a rare neurological disorder that results from brain injury during intrauterine or early years of life. Prominent cortical sulci, dilated lateral ventricles, cerebral hemiatrophy, hyperpneumatization of the sinus, and compensatory hypertrophy of the skull are the characteristic findings. We describe a female patient who presented with a history of seizure, right-sided body weakness, and neuroimaging features of left cerebral hemiatrophy, dilatation of left lateral ventricle, left frontal sinus hyperpneumatization, asymmetric calvarial thickening, and elevation of the petrous ridge.

Role of diagnostic imaging in Rasmussen's encephalitis - A case report from Nepal.

Rasmussen's encephalitis (RE) is a relatively rare chronic inflammatory neurological disease that usually only affects one hemisphere of the brain. It primarily affects children under the age of 10, although it can also affect teens and adults, causing drug-resistant seizures, progressive hemiparesis, and dementia. RE presents as a challenging diagnosis with MRI as the cornerstone of the evaluation and nuclear imaging as a complementary tool. We'd like to present a case of a 12-year-old girl who was diagnosed with RE after an MRI. In this study, we examine the diagnostic criteria, differential diagnoses, and issues that underpin the diagnostic challenge in great detail.

Deep venous sinus thrombosis with right thalamic infarction in a young patient after COVID-19 vaccination.

Cerebral venous thrombosis is a rare illness, it compromises 0.5% of cases of cerebrovascular diseases globally. The condition can be treated if discovered and treated properly and quickly. With many known risk factors and in recent times with invent of the COVID-19 vaccine, there have been reported incidences of vaccination being implicated in cerebral venous sinus thrombosis. We report an unusual case of an adolescent female with imaging findings of deep cerebral venous sinus thrombosis and right thalamic infarction after recent vaccination against COVID-19. Laboratory results revealed microcytic hypochromic anemia. Further imaging was done which included a non-contrast CT head, magnetic resonance imaging, and magnetic resonance venography leading to a diagnosis of thrombosis of deep venous (galenic) system with vasogenic edema in bilateral thalami and left caudate nucleus with areas of infarction in the right thalamus. She was treated with subcutaneous low molecular weight heparin (Enoxaparin) and discharged on the third day under oral dabigatran and oral iron.