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  1. Article ; Online: Heart stopping tick

    Paras Karmacharya / Madan Raj Aryal

    World Journal of Cardiology, Vol 5, Iss 5, Pp 148-

    2013  Volume 150

    Abstract: Although Lyme carditis is relatively rare within 4-6 wk of exposure, it can uncommonly present as the first sign of disseminated Lyme disease. Here we present 17 year old boy who presented to the emergency department with chest discomfort and was later ... ...

    Abstract Although Lyme carditis is relatively rare within 4-6 wk of exposure, it can uncommonly present as the first sign of disseminated Lyme disease. Here we present 17 year old boy who presented to the emergency department with chest discomfort and was later found to have complete atrioventricular block due to lyme carditis. He had uneventful recovery after empiric treatment with ceftriaxone. Our case highlights the importance of considering reversible causes of complete AV block since appropriate therapy can avoid the need for permanent pacemaker insertion.
    Keywords Lyme carditis ; Heart block ; Antibiotic ; Pacemaker ; Disseminated lyme ; Borrelia burgdorferi ; Tick bite ; Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Cardiovascular ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
    Language English
    Publishing date 2013-01-01T00:00:00Z
    Publisher Baishideng Publishing Group Co., Limited
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Seasonal variation of rectal foreign bodies

    Ranjan Pathak / Paras Karmacharya / Richard L Alweis

    North American Journal of Medical Sciences, Vol 8, Iss 4, Pp 191-

    Data from nationwide inpatient sample

    2016  Volume 193

    Abstract: Background: Seasonality is noted in various aspects of human behavior and functioning which have led to an increasing interest in their seasonality in the recent years. Aims: We aimed to examine the seasonal variation in the incidence of rectal foreign ... ...

    Abstract Background: Seasonality is noted in various aspects of human behavior and functioning which have led to an increasing interest in their seasonality in the recent years. Aims: We aimed to examine the seasonal variation in the incidence of rectal foreign bodies in the US using a large inpatient database. Methods: We used the Nationwide Inpatient Sample database to identify patients aged ≥18 years admitted with a primary diagnosis of the rectal foreign body from 2009 to 2011. We used the Edward′s recognition and estimation of cyclic trend method to study the seasonal variation of the incidence of rectal foreign body and Z-test to compare the seasonal incidences. Results: A total of 3359 hospitalizations with primary diagnosis of the rectal foreign body were reported from 2009 to 2011. The peak incidence of rectal foreign bodies was seen in October (peak/low ratio 1.20, 95% confidence interval [CI]: 1.10-1.32). Conclusion: Data on seasonal variation of rectal foreign bodies are extremely limited. Further studies would be required to verify whether our findings of a higher incidence in the fall season are reflective of acute changes in the length of the days, climate, sleep-wake cycle, or decreased sexual intercourse at this time of the year. High suspicion at this time of the year may help promptly diagnose and avoid unnecessary investigations.
    Keywords Nationwide Inpatient Sample ; rectal foreign body ; seasonal variation ; Medicine ; R ; Medicine (General) ; R5-920
    Subject code 310
    Publishing date 2016-01-01T00:00:00Z
    Publisher North American Journal of Medical Sciences
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Strongyloidiasis in the immunocompetent

    Niranjan Tachamo / Salik Nazir / Saroj Lohani / Paras Karmacharya

    Journal of Community Hospital Internal Medicine Perspectives, Vol 6, Iss 4, Pp 1-

    an overlooked infection

    2016  Volume 2

    Abstract: Strongyloidiasis is a parasitic infestation caused by Strongyloides stercoralis. Most cases are asymptomatic; however, symptomatic patients may present with a wide range of non-specific cutaneous, pulmonary, or gastrointestinal symptoms posing a ... ...

    Abstract Strongyloidiasis is a parasitic infestation caused by Strongyloides stercoralis. Most cases are asymptomatic; however, symptomatic patients may present with a wide range of non-specific cutaneous, pulmonary, or gastrointestinal symptoms posing a diagnostic dilemma and delay in diagnosis. We report a case of a 58-year-old female who presented with months of generalized pruritus and abdominal discomfort along with persistent eosinophilia due to strongyloidiasis, which completely resolved with treatment.
    Keywords Eosinophilia ; Immunocompetent ; Parasitic infection ; Strongyloides stercoralis ; Strongyloidiaisis ; Internal medicine ; RC31-1245
    Language English
    Publishing date 2016-09-01T00:00:00Z
    Publisher Taylor & Francis Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Heparin-induced thrombocytopenia following coronary artery bypass grafting

    Raju Khanal / Paras Karmacharya / Daniel A. Forman

    Journal of Community Hospital Internal Medicine Perspectives, Vol 5, Iss 0, Pp 1-

    a diagnostic dilemma

    2015  Volume 4

    Abstract: The diagnosis of heparin-induced thrombocytopenia (HIT) is a challenge in post-cardiac surgery patients because of the high incidence of non-immune thrombocytopenia and heparin–platelet factor 4 antibodies in these groups. We present a case of HIT in a ... ...

    Abstract The diagnosis of heparin-induced thrombocytopenia (HIT) is a challenge in post-cardiac surgery patients because of the high incidence of non-immune thrombocytopenia and heparin–platelet factor 4 antibodies in these groups. We present a case of HIT in a post coronary artery bypass surgery patient, which was successfully treated with prompt recognition and discontinuation of heparin products.
    Keywords CABG ; HIT ; heparin-induced thrombocytopenia ; serotonin release assay ; Internal medicine ; RC31-1245
    Language English
    Publishing date 2015-10-01T00:00:00Z
    Publisher Taylor & Francis Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: The red hearing

    Paras Karmacharya / Ranjan Pathak / Pragya Shrestha / Richard Alweis

    Journal of Community Hospital Internal Medicine Perspectives, Vol 4, Iss 0, Pp 1-

    swollen ear in a patient with ulcerative colitis

    2014  Volume 1

    Abstract: Relapsing polychondritis is a rare connective tissue disease of unknown etiology characterized by recurrent inflammation, degeneration and deformity of auricular cartilage. The autoimmune inflammation may also affect cartilage at other sites including ... ...

    Abstract Relapsing polychondritis is a rare connective tissue disease of unknown etiology characterized by recurrent inflammation, degeneration and deformity of auricular cartilage. The autoimmune inflammation may also affect cartilage at other sites including nose, larynx, trachea and bronchi. Here, we present a case of relapsing polychondritis in a patient with ulcerative colitis. We also review the presentation, diagnosis and management of this condition.
    Keywords cartilage disorder ; chondritis ; relapsing polychondritis ; ulcerative colitis ; Internal medicine ; RC31-1245
    Language English
    Publishing date 2014-07-01T00:00:00Z
    Publisher Taylor & Francis Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: An unusual cause of hypoglycemia in a middle-aged female after bariatric surgery

    Ranjan Pathak / Paras Karmacharya / Ahmed Salman / Richard Alweis

    Journal of Community Hospital Internal Medicine Perspectives, Vol 4, Iss 0, Pp 1-

    2014  Volume 3

    Abstract: Non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS) is a disorder characterized by postprandial hypoglycemia and islet cell hypertrophy. It is an uncommon complication of weight-loss surgery. However, with the rising incidence of gastric bypass ... ...

    Abstract Non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS) is a disorder characterized by postprandial hypoglycemia and islet cell hypertrophy. It is an uncommon complication of weight-loss surgery. However, with the rising incidence of gastric bypass surgeries, it is important to be able to recognize the clinical picture of NIPHS and not to incorrectly ascribe the symptoms to late dumping syndrome.
    Keywords NIPHS ; postprandial hypoglycemia ; nesidioblastosis ; gastric bypass surgery ; Internal medicine ; RC31-1245
    Language English
    Publishing date 2014-04-01T00:00:00Z
    Publisher Taylor & Francis Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: Cortical hemiballism

    Pragya Shrestha / Janak Adhikari / Dilli Poudel / Ranjan Pathak / Paras Karmacharya

    North American Journal of Medical Sciences, Vol 7, Iss 12, Pp 572-

    A case of hemiballismus associated with parietal lobe infarct

    2015  Volume 574

    Abstract: Context: Hemiballismus is characterized by involuntary, irregular, large amplitude, and violent flinging movements of limbs. Stroke (middle and posterior cerebral artery) remains the most common etiology with 2/3 being lacunar. Lesions outside the ... ...

    Abstract Context: Hemiballismus is characterized by involuntary, irregular, large amplitude, and violent flinging movements of limbs. Stroke (middle and posterior cerebral artery) remains the most common etiology with 2/3 being lacunar. Lesions outside the substantia niagra (STN) can cause hemiballism, and only a minority by STN lesions, unlike the classical belief. Compared to those arising from STN, cortical hemiballismus is usually less severe with a good prognosis. Case Report: A 61-year-old man presented with sudden onset involuntary flinging movements of his right upper extremity accompanied by numbness and tingling. Past medical history was significant for stroke 2 years back with no residual deficits. Vitals signs were blood pressure of 165/84 mm Hg, and heart rate - 82 beats/min. Irregular, arrhythmic, jerky flinging movement, and decreased sensation to light touch in right upper extremity was noted. Magnetic resonance imaging of the brain revealed acute posterior left parietal lobe infarction. He was treated with aspirin and atorvastatin. Thrombolytic therapy was offered but declined. The movements resolved spontaneously over the next 2 days. No further episodes occurred at 3-month follow-up. Conclusion: Lesions affecting various areas outside the STN can cause hemiballism and usually carries a good prognosis with spontaneous resolution. Acute thrombolytic therapy may be considered on an individual basis. Treatment with antipsychotics can be useful for severe and recurring symptoms.
    Keywords Antipsychotics ; hemiballismus ; hemiballism ; infarction ; parietal lobe ; stroke ; subthalamic ; Medicine ; R ; Medicine (General) ; R5-920
    Subject code 616
    Publishing date 2015-01-01T00:00:00Z
    Publisher North American Journal of Medical Sciences
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article ; Online: Down with the flu

    Ranjan Pathak / Ashish Khanal / Dilli Ram Poudel / Paras Karmacharya

    North American Journal of Medical Sciences, Vol 7, Iss 5, Pp 227-

    Hyponatremia in a patient with influenza

    2015  Volume 228

    Abstract: Context: Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a common cause of hyponatremia. Although it has been associated with different pulmonary infections, there have been only few case reports describing the association of SIADH ...

    Abstract Context: Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a common cause of hyponatremia. Although it has been associated with different pulmonary infections, there have been only few case reports describing the association of SIADH with influenza. Case Report: We report a case of SIADH in a patient with influenza who was successfully treated with fluid restriction. Conclusion: It is essential for clinicians to be aware of the association between influenza and SIADH.
    Keywords Inappropriate ADH syndrome ; Influenza ; Hyponatremia ; SIADH ; Medicine ; R ; Medicine (General) ; R5-920
    Publishing date 2015-01-01T00:00:00Z
    Publisher North American Journal of Medical Sciences
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  9. Article ; Online: Mesenteric vein thrombosis in a patient heterozygous for factor V Leiden and G20210A prothrombin genotypes

    Anthony Donato / Madan Raj Aryal / Paras Karmacharya

    World Journal of Gastroenterology, Vol 19, Iss 43, Pp 7813-

    2013  Volume 7815

    Abstract: Mesenteric venous thrombosis (MVT) is a rare but life threatening form of bowel ischemia. It is implicated in 6%-9% of all cases of acute mesenteric ischemia. The proportion of patients with primary (or idiopathic) MVT varies from 0% to 49%, with a ... ...

    Abstract Mesenteric venous thrombosis (MVT) is a rare but life threatening form of bowel ischemia. It is implicated in 6%-9% of all cases of acute mesenteric ischemia. The proportion of patients with primary (or idiopathic) MVT varies from 0% to 49%, with a decrease in frequency secondary to more recent availability of newer investigations for hypercoagulability. The presence of factor V Leiden (FVL) and prothrombin G20210A mutations (PGM) have been well documented in these cases. However, there have been scarce case reports describing MVT in heterozygotes of both these mutations occurring simultaneously and its implications on long term management. Our case describes acute MVT in a previously asymptomatic young patient with no prior history of venous thromboembolism. The patient was found to be heterozygous for FVL and PGM and treated with lifelong anticoagulation with warfarin (goal international normalized ratio: 2-3) and avoidance of hormonal contraceptives.
    Keywords Mesenteric vein thrombosis ; Prothrombin gene ; Factor V Leiden ; Heterozygous ; Anticoagulation ; Oral contraceptives ; Diseases of the digestive system. Gastroenterology ; RC799-869 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Gastroenterology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
    Subject code 610
    Language English
    Publishing date 2013-01-01T00:00:00Z
    Publisher Baishideng Publishing Group Co., Limited
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  10. Article ; Online: Touch me not

    Paras Karmacharya / Kalpana Shah / Ranjan Pathak / Sushil Ghimire / Richard Alweis

    Journal of Community Hospital Internal Medicine Perspectives, Vol 4, Iss 0, Pp 1-

    2014  Volume 3

    Abstract: Central Poststroke Pain syndrome (CPSP) can occur due to disruption of the somatosensory pathways of the brain at any level such as the thalamus, medulla, or cerebral cortex. It is characterized by sensory abnormalities and hyperesthesia in the part of ... ...

    Abstract Central Poststroke Pain syndrome (CPSP) can occur due to disruption of the somatosensory pathways of the brain at any level such as the thalamus, medulla, or cerebral cortex. It is characterized by sensory abnormalities and hyperesthesia in the part of the body correlating to the central lesion. The treatment of this pain syndrome is often difficult, and it does not usually respond to traditional analgesics. The first line of treatment is drugs aimed at lowering neuronal hyperexcitability, for example, amitriptyline or lamotrigine, with gabapentin considered a second line.
    Keywords thalamic pain syndrome ; Central Poststroke Pain ; Déjerine Roussy syndrome ; neuropathic pain ; gabapentin ; Internal medicine ; RC31-1245
    Language English
    Publishing date 2014-02-01T00:00:00Z
    Publisher Co-Action Publishing
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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